REPORTS TO: CLINICAL SUPERVISOR, COMMUNITY CARE SERVICES

Responsible for the day-to-day management of care coordinators’ activities to CCS members. Responsible for the utilization management of CCS members assigned to care coordinators on team. Works collaboratively with other care managers toward these purposes.

ESSENTIAL JOB FUNCTIONS:
Care Coordination

1.Supervise care coordinators in the performance of their day-to-day activities to include:
a.Screens, prioritizes and assigns duties and responsibilities to care coordinators.
b.Conducts clinical team meetings.
c.Periodically reviews member charts for quality.

2.Provides direction to care coordinators on difficult or complex cases.

3.Provides direction to care coordinators in contacting BHPs and coordinating care/treatment plans with them.

4.Generates clinically related reports, as requested by management.

5.Responsible for care coordinators’ scheduling and the development of on-call coverage scheduling. 

6.Provides in-service training in area(s) of expertise.

7.Participates in the development and review of policies and procedures relating to care coordination.

8.Hires and completes performance reviews for care coordinators.

Utilization Management

9.Completes precertifications for all levels of care included on the Individual Care Plan (ICP) for members assigned to team.

10.Completes precertification reviews for all levels of care that are not included on the ICP. Consultation with the BHP should occur before authorizations are determined and any changes to the ICP

11.Perform concurrent reviews for intensive outpatient, outpatient, crisis beds, in-community stabilization and pre-vocational placements.

12.Coordinates with team liaisons on concurrent reviews for members in inpatient, residential, and partial levels of care.

13.Documents UR activities (precertifications, concurrent and retrospective reviews) according to CCS Polices and Procedures.

14.Regularly consults with CCS Medical Director, Program manager, BHPs, and care coordinators to review ICP for CCS members.

15.Maintains an authorization tracking system with clear, concise records for monitoring and reviewing cases per policy.

16.Participates in CCS 24 hour on-call roster.

17.Guides the nature and flow of clinical services to CCS members through consultation and training with network providers; authorizations; and regular review of treatment plans for all members being seen by providers.

18.Contributes to utilization management endeavors, policy review, and procedure development and evaluation.
 
General

19.Participates in the APS/Quality Improvement system and activities for the CCS program.

20.APS Healthcare employees are expected to maintain a positive work atmosphere through communicating and behaving in a manner that is courteous and respectful of customers, clients, co-workers, and supervisors. 

21.Performs other duties as assigned.

JOB SPECIFICATIONS:
Minimum Qualifications:Bachelor’s (or higher) degree in a health-related field and licensure as a health professional; or

Certification as a case manager, LPN, LSW, LCSW or RN licensure in the State of Hawaii and three (3) years clinical practice experience and, 

Minimum Experience:
Minimum of three years experience in direct inpatient and outpatient mental health clinical care. 

Utilization management and case management experience preferred. 

Minimum of two years supervisory experience.

Other Experience:
Excellent clinical assessment, crisis intervention, and therapeutic skills with mental health and/or substance use disorders. 

Skilled in balancing clinical and financial issues in care management decisions, adept in directing clinical work teams and gathering critical reporting data. 

Knowledge of various public and private services available for the mentally ill and the substance abuser. 

Independent, highly organized team player, able to handle multiple tasks simultaneously. 

Knowledgeable in case management software systems and Microsoft Office suite of applications.

Excellent communication skills. 

Must be able to access, research and extract information from printed and online resources. 

Ability to operate copier, fax machine, and telephone. 

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as classified.
 

 Country:U.S.
 

 State:Hawaii
 

 City:Honolulu

 


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