Job description

Office Location: Available for any of Partners' locations; Remote option available

Work Schedule: PRN with Monday-Friday 8a-5p availability
Projected Hiring Range: Depending on Experience
Closing Date: Open Until Filled

Primary Purpose of Position: This position provides the initial screening, referral and or scheduling of members who call the toll-free PartnersACCESS Member Services number seeking health and behavioral health services and as appropriate, transfers the member to a clinician who will clinically triage/assess the member’s acuity and will determine what type and intensity of service the member needs and/or is eligible to receive.

Role and Responsibilities:

Screening, scheduling and referral:

Initial screening of Health/Mental Health (MH)/Substance Use (SU)/Traumatic Brain Injury (TBI)/Intellectual/Developmental Disability (I/DD) treatment needs, benefit information and referral of members calling to determine if they may potentially qualify for services
Collect and enter demographic data into the electronic record, completion of appropriate forms, explanation of services, benefits and resources, verifies Medicaid and dispatch
Provide follow up calls to referral sources and members to ensure that members have been successfully engaged in services
Make referrals to clinical homes and crisis providers that meet the timeliness standards as defined by NC Medicaid
Provide information about local community resources, independent practitioners, and related providers for referrals for basic benefit services
This position demands a high level of accuracy and confidentiality. Information must be handled according to NC standards and rules, state and federal laws and LME/MCO and NCQA standards, procedures, policies and protocol

Authorizations:

Assists with authorizations/admissions to state hospitals, ADATC, Three Way Hospitals, Level III Detox, Facility Based Crisis and all referrals to crisis services
Process other acute care authorizations as requested by supervisor or other Access to Care Licensed Clinician

Automation:

Screenings are completed using standard and specialized computer programs
Inputs accurate information into the system and unlocks electronic service records with appropriate consents, enters all necessary data elements into data systems
Provide technical assistance to First Responders, clinical home providers, and Mobile Crisis Management

Cooperative Efforts:

Establish and maintain effective working relationships within the unit, agency, and service system
Consistently demonstrate professionalism, tact and diplomacy in handling irate callers and/or working with contract providers and other external parties
Participate in Unit Staff meeting, Agency Staff meetings, (All staff meetings) and assigned committees

Knowledge, Skills and Abilities:

Sound knowledge of health/MH/SU/TBI/I/DD for the appropriate determination of eligibility for Medicaid and State supported services, appropriateness of referrals for treatment and assessment and the level of danger of the members calling for assistance
Knowledge of the laws governing the treatment of health, mental illness, substance abuse and intellectual/developmental disabilities as well as the resources available in the community for treatment
Knowledge of call center functions, member population, potential for crisis issues, confidentiality laws and program protocols/policies
Excellent computer skills
Ability to complete tasks independently, define problems, apply laws, policies and procedures to agency activities and must use sound judgment in conducting screening, triage and referral
Ability to use sound judgment when conducting a screening and be able to determine when it is necessary and appropriate to transfer a member to a Licensed Access to Care Clinician
Ability to communicate effectively orally and in writing, have good keyboarding skills and be able to multi-task (that is: converse while entering screening information into the electronic medical record and evaluating the member’s need)
Ability to take highly complicated criteria and apply it to cases in determining eligibility for services and appropriate scheduling referrals
Ability to assist members in highly stressful situations which may be life threatening to the member or public while at the same time facilitating a connection to crisis services and/or a Licensed Access to Care Clinician
Ability to provide technical assistance to both members and Providers
Ability to maintain confidentiality when screening and referring calls/callers

Education/Experience Required: Bachelor’s Degree in related field or Licensed Practical Nurse (LPN) and at least two (2) years of healthcare or MH/SU/IDD experience.

Education/Experience Preferred: Licensed practical nurses (LPNs) and at least four (4) years of healthcare and/or MH/SU/IDD experience.

Licensure/Certification Requirements: N/A

Required profile