Clinical Specialist—Self-Determination
Under the direct supervision of the I/DD Program Administrator and general supervision of the Director of Utilization Management, the Self-Determination Specialist will ensure that DWIHN and its provider network observes state and local Self-Determination policies, standards, rules, Determination Specialist will ensure that DWIHN and its provider network observes state and local Self-Determination policies, standards, rules and regulations to support individuals with an intellectual/developmental disability, serious mental illness, and/or co-occurring disorders.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Supports the Person-Centered Planning process by implementing the operational tasks for individuals who Self-Direct their services.
- Participate in the development of the Individual Budget process.
- Ensure that the components identified by MDHHS regarding Self-Directing services are in place for each individual who Self-Directs their services.
- Ensure the Person-Centered Planning process is followed.
- Ensure authorizations are supported in the Individual Plan of Service, agreements are in place, and an individual budget is developed.
- Serves as the primary contact for Clinically Responsible Service Providers for Self-Determination.
- Serve as an agency expert about Self-Determination and Self-Directing services for internal staff, network providers, families, and stakeholders.
- Ensure authorizations and budgets are equitable to meet the needs of all individuals who receive services.
- Ensures Medicaid is the payor of last resort by verifying that entitlements, community resources, and natural supports are exhausted prior to approving authorizations.
- Ensure timely dispositions for all service authorization requests, including denials and appeals.
- Verifies current standardized assessments depending on disability designation (e.g., LOCUS, MichiCANS, CAFAS, PECFAS).
- Utilizes Clinical Practice Guidelines and the content of the Service Utilization Guidelines to inform decisions.
- Coordinates with the Utilization Manager for the Habilitation Supports Waiver (HSW) to provide the names of individuals who may benefit from the HSW.
- Collaborates with the Program Administrator to establish training and measurable quality improvement markers for the Person-Centered Planning process, especially targeting goal development.
- Facilitates monthly meetings with Clinically Responsible Service Providers to discuss operational processes, barriers, or updates to ensure ongoing quality improvement.
- Establishes a monthly review process to ensure IPOSs are not missing signatures.
- Educates and trains DWIHN internal staff and external network providers on the Principles of Self-Determination.
- Works in conjunction with other DWIHN departments and various workgroups or special projects to improve agency efficiency.
- Contributes knowledge and experience to identify system barriers and develop process improvements.
- Serves as one of the liaisons to the Financial Management Service agencies.
- Works in conjunction with the Financial Management Service Coordinator to maintain quality and efficiency for individuals who Self-Direct services.
- Performs data gathering, documentation, and analysis for desired outcomes.
- Tracks and monitors cost factors relative to service utilization, treatment activities, and other criteria.
- Monitors provider services for adherence to priority Federal, State, and Medicaid admission requirements.
- Performs related duties as assigned.
Knowledge, Skills, and Abilities (KSAs):
- Knowledge of Self-Determination, Self-Directing Services, Person-Centered Planning, Home and Community-Based Services, and NCQA standards.
- Knowledge of MDHHS’ Self-Determination and Person-Centered Planning policies.
- Knowledge of PIHP/CMHSP encounter reporting.
- Knowledge of HCPCS and Revenue Codes.
- Knowledge of the Medicaid definitions for the most frequently used Self-Directed services, Community Living Supports, and Respite.
- 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 and ability to use screening and assessment tools for behavioral health services.
- Knowledge of medical and behavioral health practices and terminology.
- Knowledge of Utilization Management practices and principles.
- Knowledge of regulatory and industry best practice standards.
- Assessment skills.
- Report writing skills.
- Reasoning skills.
- Decision-making skills.
- Communication skills.
- Computer 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 (a Bachelor’s Degree will be accepted), Human Services, Social Services, or a related field.
REQUIRED EXPERIENCE:
Five (5) years of full-time professional experience in behavioral healthcare performing care coordination for people with serious mental illness, co-occurring disorders, and intellectual or developmental disabilities, and self-directing services.
REQUIRED LICENSE(S).
A Valid State of Michigan clinical licensure in a Human Service area that qualifies for full licensure as a LMSW, LMHC, LPC, or LLP.
A valid State of Michigan Driver’s License with a safe and acceptable driving record.
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
