PartnersACCESS Specialist QP (PRN; Remote Option)

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