Clinical Care Specialist

POSITION SUMMARY: The Clinical Care Specialist performs various clinical tasks supporting the training and monitoring functions of Advanced Behavioral Health, specifically related to performance of responsibilities associated with the 1115 Waiver Demonstration Project contract and the utilization management functions of the Behavioral Health Recovery Program.

This position will represent ABH® and its services in a positive and professional manner and adhere to ABH®’s best practices, guidelines, policies and procedures as established, promoting ABH® as a leader in behavioral healthcare in all interactions and work.

DUTIES AND RESPONSIBILITIES: Performs clinical review of behavioral health cases including, but not limited to, maintaining familiarity and understanding of contract requirements related to the daily performance of clinical activities; provide telephone (ACD) coverage for incoming telephone calls to the clinical line for pre-certification, concurrent review, and information and referral calls.

Hours of coverage and call volume are assigned by the Clinical Care Team Leader and are determined by business needs; Document fully and appropriately all clinical data collected during the review process, meeting all contract performance standards for documentation.

This documentation should include, but not be limited to, Pre-/Post-Admission, Continued Stay, Discharge and Informational Reviews; Develop and demonstrate a clear and thorough understanding of the most current edition of the American Society of Addiction Medicine (ASAM) Level of Care Criteria and Connecticut Substance Use Disorders Services Policy and Clinical Assumptions Grid or equivalent document; Perform chart reviews remotely or on-site at provider agency using the Chart Monitoring Tool, including assisting the Clinical Care Team Leader in presenting a summary of findings to the provider; Perform or assist the Clinical Care Team Leader in presenting Provider Training, via video-conference or on-site visits, to increase understanding and application of ASAM criteria and other level of care-specific requirements as outlined in the Connecticut Substance Use Disorders Services Policy and Clinical Assumptions Grid (or equivalent document); Perform chart reviews of substance use residential episodes of care using the established Chart Monitoring Tool remotely or via on-site visits to provider agencies to determine whether the episode meets the level of care-specific requirements; Perform Site Monitoring assessments using the established Site Monitoring tool during on-site visits to provider agencies, consulting the Clinical Care Team Leader as needed.

Assist the Clinical Care Team Leader in presenting the results of the site visit to agency staff; As necessary, participate in targeted technical assistance and training for providers in collaboration with the Clinical Care Team Leader; Maintains confidentiality of all client protected health information and adheres to all HIPAA related reviews, goal setting, etc; Demonstrates ethical behavior and cultural sensitivity in all activities involving individuals of diverse backgrounds; Performs other tasks/responsibilities as required to support the business operations.

EDUCATION AND EXPERIENCE REQUIREMENTS: Master’s degree with licensure in appropriate field required; 5 years of demonstrated work experience in behavioral health, with preference given for experience in substance use disorders treatment field; Active State of Connecticut professional license (RN, LCSW, LMFT or LPC) required; Behavioral health treatment professionals with current, active State of Connecticut professional license.

Examples include Registered Nurses (RN), Licensed Clinical Social Workers (LCSW), Licensed Marriage/Family Therapist (LMFT), or Licensed Professional Counselor (LPC); Must have valid Driver’s license and reliable transportation; Attends annual conflict of interest training.

KNOWLEDGE/SKILLS/ABILITIES: Basic understanding of ASAM Level of Care Criteria; Flexibility in order to respond quickly and positively to shifting demands and changing management opportunities; Capability of traveling to provider sites as needed to provide technical support and assistance related to utilization management functions; Strong attention to detail; ability to work on multiple tasks and meet deadlines; Excellent PC skills with demonstrated experience using Microsoft Office Package (MS Word, Excel, Power Point, Access, Outlook); internet; Strong written and verbal communication skills required.

ENVIRONMENTAL FACTORS AND PHYSICAL REQUIREMENTS: While performing the duties of this job, the associate is required to have ordinary ambulatory skills sufficient to visit other locations and the ability to stand, walk, stoop, kneel, crouch, and manipulate (lift, carry, move) light to medium weights of 10 – 20 pounds.

Requires good hand-eye coordination, arm, hand and finger dexterity, including ability to grasp and visual acuity to use a keyboard, operate equipment and read application information.

The associate frequently is required sit, reach with hands and arms, talk and hear.

Regularity and consistency of attendance is essential to ensure high quality service and ultimately a productive department and company.

NOTE: To perform this job successfully, an individual must be able to perform each essential job function satisfactorily with or without reasonable accommodations.