Under the general supervision of the Director of Crisis Services, the Clinical Specialist (PAR Services) implements the DWIHN Utilization Management Plan in the Crisis Environment. This position provides informal assessments, planning, linkage, advocacy, coordination and monitoring to assist persons experiencing a behavioral health crisis in gaining access to needed crisis services as medically appropriate and in the least restrictive environment.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Provides informal assessments, planning, linkage, advocacy, coordination and monitoring to assist persons experiencing a behavioral health crisis in gaining access to needed crisis services as medically appropriate and in the least restrictive environment.
- Uses clinical information obtained to assist community partners in crisis placement.
- Facilitates clinical conversations between placements and DWIHN.
- Provides technical assistance and oversight to providers of crisis intervention services and crisis focused treatment to clients.
- Provides support to crisis intervention teams in placing consumers in appropriate settings.
- Provides consultation on cases to reduce recidivism in inpatient placements and emergency room visits.
- Provides short-term, solution-focused, supportive, crisis counseling to individuals and/or families as necessary.
- Establishes and maintains constructive and cooperative working relationships with co-workers, hospital staff, and other community partners.
- Monitors the census of the crisis residential services, emergency departments, crisis support, inpatient admissions, patients that flow through triage, the 23-hour care and sub-acute units.
- Consults with hospitals, crisis residential and co-located staff to obtain a comprehensive clinical picture of all patients, in particular, those who are in crisis and whose disposition includes placement in an inpatient psychiatric facility.
- Assists in the identification of community resources and services to promote timely discharge.
- Ensures that members who are in crisis awaiting a placement are able to secure a bed.
- Conducts concurrent reviews on consumers.
- Coordinates and communicates with other systems, networks and providers to ensure member’s needs are met through the utilization process.
- Ensures discharge planning at disposition and coordinate services to ensure individuals are connected and engaged with an assigned Clinically Responsible Service Provider (CRSP) as identified by the individual being served.
- Coordinates the level of care determined from the disposition, i.e., inpatient placement, Crisis Residential, Partial Hospitalization, Residential Placement, Outpatient, etc. for discharge planning.
- Obtains required information to serve assigned persons.
- Develops and communicates expectations to ensure that the provider of services (including primary health) have all relevant individual information to successfully implement the plan of care and provide effective services.
- Monitors and identifies health changes and takes appropriate action for the consumer.
- Facilitates meetings with crisis screeners, emergency room staff, psychiatric inpatient hospital staff, DHS staff and CRSP.
- Completes special projects.
- Researches and develops policies and procedures to effectively implement DWIHN’s crisis continuum.
- Applies medical necessity criteria to determine level of care.
- Utilizes motivational interviewing and or other engagement/communication tools.
- Assists consumers in obtaining services that suit his/her individual medical, psychiatric and social support needs.
- Coordinates discharge planning.
- Performs related duties as assigned.
KNOWLEDGES, SKILLS AND ABILITIES (KSA’S):
- Knowledge of DWIHN policies, procedures and practices.
- Knowledge of the DWIHN provider network and community resources.
- Knowledge of the Michigan Mental Health Code.
- Knowledge of MDHHS policies, rules, regulations and procedures.
- Knowledge of the clinical care process (screening, assessment, treatment planning, case management, and continuing care).
- Knowledge of Medicaid, local, regional and national codes, laws and regulations.
- Knowledge of medical and behavioral health practices and terminology.
- Knowledge of compliance standards.
- Knowledge of Medical Necessity Criteria for Behavioral Health services, American Society of Addiction Medicine Patient Placement Criteria (ASAM) and the Federal Confidentiality Regulations, 42 CFR, Part 2.
- Knowledge of SUD treatment modalities/programs.
- Knowledge of documents / regulations that govern the provision of mental health services, e.g., Medicaid Manual Mental Health and Substance Abuse Chapter III, State Plan for Medicaid, Michigan Department of Health and Human Services Quality Plan, BBA requirements and the Mental Health Code.
- Knowledge of the practices and principles of psychological, emotional, and sociological assessment and diagnosis.
- Knowledge of crisis training and experience in de-escalation, i.e., suicide prevention, development of crisis plans, trauma informed care, etc.
- Knowledge of diagnostics, psychopharmacology, and supportive treatment approaches as applied to a severely mentally ill (SMI) adult population.
- Knowledge of the identification and treatment of co-occurring mental health and substance abuse disorders.
- Knowledgeable of psychotropic medications.
- Knowledge of Pre-Admission Review (PAR) Screening.
- Knowledge of tools utilized to determine medical necessity criteria.
- Knowledge of Service Utilization Guidelines.
- Knowledge of medical benefit plans
- Knowledge of medical terminology.
- Assessment and evaluation skills.
- Conflict Resolution skills
- Interviewing skills.
- Corrective Action skills.
- Computer skills.
- Organizational skills.
- Report writing skills.
- Negotiation skills.
- Problem Solving skills
- Decision Making skills.
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Interpersonal Skills.
- Communication skills.
- Collaboration skills.
- Multitasking skills.
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Teamwork Skills.
- Ability to communicate orally.
- Ability to communicate in writing.
- Ability to work effectively with others.
- Ability to work with an ethnically, linguistically, culturally, economically and socially diverse population.
- Judgement/Reasoning ability
REQUIRED EDUCATION:
A Master’s Degree in Social Work, Psychology, Counseling, Nursing, the Human Services, the Social Services or a related field.
REQUIRED EXPERIENCE:
Five (5) years of clinical experience in a psychiatric or behavioral health setting.
AND
At least three (3) years of professional experience in the following:
- Behavioral health utilization review.
- Management experience in a community mental health setting.
REQUIRED LICENSE(S).
A Valid State of Michigan clinical licensure: RN, LMSW, LMHC, LPC, LLP or PhD.
NOTE: An applicable Limited License will be accepted for this position.
A valid State of Michigan Driver’s License with a safe and acceptable driving record.
WORKING CONDITIONS:
Work is performed mostly in hospital settings.
This position requires local travel by personal vehicle to areas such as emergency rooms and hospitals within and outside of Wayne County. This position also requires travel throughout the State of Michigan.
Candidates must be able to work a flexible employment schedule.
This description is not intended to be a complete statement of job content, rather to act as the essential functions performed. Management retains the discretion to add or change the position at any time.
Please Note: DWIHN requires proof of being fully vaccinated for COVID-19 as a condition of employment. Medical or religious accommodations or other exemptions that may be required by law, will be approved when properly supported. Further information will be provided during the recruitment process.
The Detroit Wayne Integrated Health Network is an Equal Opportunity Employer