Quality System Specialist

Description:

POSITION SUMMARY

The Quality System Specialist will identify, assign and monitor cases for the Intensive Case Management Program.  The Quality System Specialist will work with the providers, ABH clinical staff, ABH Recovery Specialists and other contacts to ensure timely and appropriate identification, assignment, and monitoring of individuals on Medicaid LIA with substance abuse or mental health disorders.   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:

  • Identification and Assignment of individuals for enrollment into ICM and any special initiatives;
  • Log onto queue line daily and be available to take provider and/or client referral information for assignment to ICM.  This includes obtaining basic information from the caller and determining the appropriateness of case management services as quickly as possible and gathering any additional information including the Release of information;
  • Review daily list of authorization and forward relevant authorization information to case manager and / or regional coordinator; Track re-admission data on a daily basis and monitor caseloads for connections to lower levels of care and notify Recovery Specialist and Regional Coordinators;
  • Track individuals in treatment and contact providers to obtain signed Release of Information; 
  • Pending receipt and registration of appropriate ROI, obtain all available information from ABH® database, and EMS database; review information to make determination about assignment to Recovery Specialist and recommendations about intervention types and frequency; client assignments will take into consideration such factors as primary location of client, existing caseload distributions of Recovery Specialists, client cultural background, complexity of client’s needs and social risk factors, acuity of client’s symptoms and risk of dangerous behaviors and staff competencies, skill sets, strengths and weakness;
  • Monitoring recovery specialist’s compliance with documentation standards by ensuring accurate and timely entering of all documentation in the electronic record of a client.  This includes but is not limited to monitoring and auditing screening, recovery plan, assessments, and client activity notes; 
  • Ensure program outcomes meet contract standards by closely monitoring the electronic record and working with the Recovery Specialist and Regional Coordinator to audit data on a regular basis;
  • Prepare monthly reports as requested;
  • Attend client based provider treatment team meetings with or without the Recovery Specialist, as needed;
  • Attend and represent ABH® at community forums such as but not limited to; emergency room grid lock meetings, community care teams, regional case management meetings, etc.;
  • Schedule and attend provider outreach meetings for the purpose of facilitating referrals to the intensive case management program. Provide telephonic outreach to providers to encourage and follow up on referrals to the intensive case management program;
  • Review and approve client discharge request submitted by Recovery Specialist including verifying all necessary documentation (i.e. notes, assessments, status updates, etc) are complete;
  • Attend all required staff, supervision and training meetings (held throughout Connecticut);
  • Maintains confidentiality of all client protected health information and adheres to all HIPPA related policies and procedures;
  • 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.

SUPERVISORY DUTIES AND RESPONSIBLITIES:

Provide supervisory coverage for case management staff in the absence of regional coordinator or assistant program manager as needed.  This includes but is not limited to taking calls from recovery specialists, monitoring daily activity and assisting with client activity if needed
EDUCATION AND EXPERIENCE REQUIREMENTS

  • Master’s level with at least five years of experience in behavioral health care setting required;
  • Attends URAC trainings specific to job duties;
  • Attends annual Conflict of Interest training.

KNOWLEDGE/SKILLS/ABILITIES:

  • Demonstrated leadership, organization and planning skills;
  • 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;
  • Must have valid CT Driver’s License and reliable transportation.


If your qualifications match these job requirements and you are interested in pursuing this potential position and joining a dynamic company, please apply on-line at www.abhct.com. include resume, letter of interest and salary requirements/range. 

                 ABH® is an Equal Opportunity Employer

 

 

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We are an Equal Opportunity Employer.


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Advanced Behavioral Health, Inc.

213 Court Street
Middletown, CT 06457

Phone: (860) 638-5309
Fax: (860) 638-5302