Behavioral Health Clinical Care Coordinator - Serene Health

JOB SUMMARY 

The Clinical Care Coordinator (CCC) is a holistic role, participates in the Implementation of the Utilization and Population Health Management Program, supports Quality Management initiatives and the Recovery model of care in meeting the needs of his or her caseload. Ensures that all primary clinical functions as well as clinical services coordinated meet plan requirements and organizational standards and expectations. The CCC follows the member thru the continuum of care. provide interface support with the Health Plans, Medical Groups, facilities, resources, community groups and providers per CM/CCM processes. The CCC reports to and collaborates with the senior CCC and Medical Director/Physician Champion to ensure quality care and services for the population served. Ensures that the Utilization Management/Population Health Plan is implemented. Integrates CM/CCM case management with day-to-day functions of the clinical team.  

ROLE AND RESPONSIBLITIES 

Population Health Management/Case Management and Complex Case Management Responsibilities; 

• Monitors data sources to identify potentially qualifying PHM CM/CCM members
• Identifies Members meting Criteria for the PHM/Virtual Wards program.
• Facilitates enrollment (outreach via telephone, email, written notice of invitation) and completion of the Initial Assessment. 
• Participates as directed in the collection and analysis of pertinent clinical data...
• Performs all functions associated with the Population Health Management Program in tandem with the Physician Champion.  
• Conduct case management and complex case management outreach calls, letters and surveys as defined in the UM Plan annually 
• Perform CCM functions; IA, SMART goals, modified health plans as indicated, perform monthly member contact, liaison with MG and PCP as warranted 

Standard Clinical Responsibilities; 

• Fully understands and applies policies, procedures and organizational operations as related to job functions including Apollo Medical Necessity Criteria and ASAM criteria, URAC, NCQA, JCAHO and HEDIS standards and Health Plan or Medical Group requirements.  
• Adheres to established operational policies and procedures. 
• Utilizes the most current clinical and level of care criteria as approved by Peer Review Committee and Executive/QI Committee.  
• Manages and coordinates member benefits and individualized treatment delivery to achieve optimal patient outcomes in CM/CCM program, then post program discharge across the continuum of care. 
• Participate in team, meetings, training, staffing and educational sessions. including weekly clinical team meetings.
• Utilizing the analysis of data collected identifies opportunities for improvement and development of quality improvement initiatives. 
• Identifies and implements program changes. Alerts leadership o Ensures compliance with Accreditation Standards and regulatory requirements. o Maintain Continuing Education Units as required per clinician's licensure and/or  certification or degree.  
• Participates in clinical Inter-Rater compliance audit of clinical criteria application and  timeliness of decision making  
• Participates in preparation, implementation of corrective action to cure deficiencies as  identified 
• Liaison between PsycHealth clinical functions and it's BH Medical Director 

Additional Clinical Team Responsibilities:

• Supports and responds to incoming telephone calls regarding clinical needs including crisis calls, urgent and emergent care requests, authorization of inpatient and outpatient service requests, inpatient and outpatient concurrent and post service reviews. 
• Provides clinical team back-up with portal maintenance, scheduled um reviews- PHP, IOP,RTC per division of responsibilities  
• Identify cases requiring either concurrent or post service review by Medical Director or Physician Advisor. 
• Fosters service integration, in compliance with state and federal regulations, between contracted providers, primary care and other medical providers, and community resources, programs and supports such as child welfare, human services, employers, schools, law enforcement and other government agencies. 
• Clinical data documentation preparation and reporting for review/audit as needed by the organization regarding utilization and criteria to ensure timely, accurate and compliant case review. 
• Supports functions associated with implementation, integration and maintenance of PsycHealth Clinical Programs directly and indirectly associated with the PHM program 
• Other duties as assigned. 

EDUCATION, TRAINING, EXPERIENCE, and/or SKILLS

• Bachelor's Degree in Nursing, or a Master's degree in Psychology, Social Work, Counseling (or related mental health field) from an accredited college or university. 
• Minimum of three (3) years experience in direct patient behavioral healthcare. 
• Minimum of two (2) years experience in case management, discharge planning, and/or utilization review.  
• Managed Care Experience. 
• Excellent oral and written communication skills. 
• Computer skills and typing proficiency a must. 
• Microsoft Excel and Access background a plus. 
• Maintains knowledge and understanding of URAC, NCQA, JCAHO and HEDIS standards. 
• Must be detail oriented and able to effectively organize information while multi-tasking. 
• Ability to function independently as well as part of a clinical team and a larger organizational structure 

LICENSURE, CERTIFICATIONS or CREDENTIALS

• Current, unrestricted clinical license, to practice medicine or a health profession that is issued by any state or jurisdiction in the United States; and 2) required for the performance of the job functions and/or 
• Certified AODA Counselor (CADC) 

SUPERVISION RESPONSIBLITIES 

• CCCs maintain no direct supervision responsibilities.  
• CCCs as directed assist in the training and orientation of new clinical staff members.  

LEVEL OF DECISION MAKING 

• CCCs utilize appropriate clinical decision support tools in order to determine either to certify requests for authorization of services or to turn the case over for physician review.  o Coordinates with Medical Directors cases where adverse determination or denial may be indicated. Does not make denial determination. 
• CCC's cannot make decisions not to certify services based on medical necessity criteria.  

SYSTEM ACCESS 

• Utilization Management database 
• Provider database- portal search  
• PsycHealth portal 
• Shared Company files 

SPECIAL REQUIREMENTS 

• Provide primary and back-up on-call services, as necessary.

This is a Part-time position and is not eligible for our benefits package.