Under the general supervision of the Clinical Specialist-Complex Case Management and the Director of Integrated Care, the PIHP Complex Case Manager monitors and manages care coordination initiatives. This position also helps to guide DWIHN, its provider network and the healthcare community in progressing toward a holistic, integrated, and broad ranged service model.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Monitors and manages care coordination initiatives. 
• Assists DWIHN, its provider network and the healthcare community in progressing toward a holistic, integrated, and broad ranged service model.
• Follows NCQA guidelines for Complex Case Management.
• Maintains a caseload of DWIHN members.
• Completes required documentation in MHWIN in a timely manner.
• Visits DWIHN members in the hospital or community settings. 
• Completes assessments and plans of care within the required time frames.
• Identifies eligible members through various sources i.e., Hospital inpatient lists, EMS lists, PHQ, Hospital Recidivism, etc..
• Oversees marketing and education of Wayne County Community Providers.
• Receives and responds to complex case management referrals in the designated time frames.
• Completes weekly and monthly reports.
• Provides transitions of care support for DWIHN members who are discharged from acute care settings.
• Maintains a compiled list/data of members for reporting requirements.
• Coordinates with member care teams at the community level.
• Connects members with community resources and health providers.
• Assists members with applying for health benefits, SSI, bridge card etc..
• Participates in care review mock audits and file reviews.
• Provides care coordination for members who are not eligible for Complex Case Management.
• Attends weekly team meetings, all staff meetings and other DWIHN meetings as necessary.
• Attends CRSP, COPE, Children, Hospital Liaison meetings as designated.
• Attends DWIHN training courses and any other training as required.
• Performs related duties as assigned.

KNOWLEDGES, SKILLS AND ABILITIES (KSA’S)

• 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 Federal policies, rules, regulations, and procedures as it relates to DWIHN.
• Knowledge of MHWIN
• Knowledge of the LOCUS model.
• Knowledge of the clinical care process (screening, assessment, treatment planning, case management, and continuing care).
• Knowledge of the Adult continuum of care for all disability designations (I/DD, SMI, Co-Occurring Disorder).
• Knowledge of adult services: Outpatient, Co-Occurring services, CM, ACT, Supported Employment, Supports Coordination and Med Drop. 
• Knowledge of Integrated Care services for behavioral health patients
• Knowledge of Medicaid, local, regional, and national codes, laws and regulations.
• Knowledge of Medical Necessity Criteria and Service Utilization Guidelines for Behavioral Health Services.
• Knowledge of the American Society of Addiction Medicine Patient Placement Criteria (ASAM).
• Knowledge of resources for each level of care of admission ranging from inpatient to outpatient and including substance use.
• Knowledge of regulatory and industry best practice standards.
• Knowledge of Community Mental Health Services Programs (CMHSP) and Prepaid Inpatient Health Plans (PIHP).
• Knowledge of Integrated Care methodology, practice, and implementation.
• Knowledge of the DSM-V Statistical Manual.
• Knowledge of NCQA guidelines. 
• Assessment skills.
• Evaluation skills.
• Attention to detail skills.
• Time Management skills.
• Report writing skills.
• Critical Thinking skills.
• Interpersonal skills.
• Communication skills.
• Active Listening skills.
• Computer skills (Word, Excel, Access, Power Point, Outlook, Teams).
• Teamwork 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 Bachelor’s Degree in Social Work, Psychology, Counseling, Nursing, the Human Services, the Social Services, Public Health, Public Administration, Healthcare Administration, Health Management, Psychology, Social Work or a related field.

REQUIRED EXPERIENCE:

• Four (4) years of full-time paid professional experience working in a human service, social service, mental health, or behavioral health setting.

REQUIRED LICENSE(S).

Licensed Bachelor’s Social Worker (LBSW) or higher-level license.

A valid State of Michigan Driver’s License with a safe and acceptable driving record.

WORKING CONDITIONS:

Work is usually performed in an office setting but requires the employee to drive to different sites throughout Wayne County and the State of Michigan. This position can work remotely with supervisory approval. Currently this position is primarily a remote position.

This description is not intended to be a complete statement of job content, rather to act as a general description of 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