What are the responsibilities and job description for the Clinical Program Consultant position at AppleOne Employment Services?
PROGRAM CONSULTANT – CONTRACTUAL DUTIES
Training & State Requirements
• State mandated training to the entire statewide Care Coordination Organization (CCO) network (this is regulated by the state and each MCO MUST provide this training)
• State mandated tier exception requests to HCA
• Bi-Monthly State Training Committee meetings and follow ups to network
Clinical & Supervisory Responsibilities
• Coordinated with BH And PH teams and provides clinical consultation
• Supervises internal CC and provides clinical consultation
• Clinical consultation on complex clients
• Clinical Account Management for CCOs including routing of emails to appropriate person, responding to emails, access issues, IT, billing, member services)
• Liaison to DSNP HH program
Policy, Auditing & Compliance
• Creates Policies and Procedures
• Audits 10% of engaged Health Homes charts (this is a TEAMonitor Contract requirement and is typically about 100 charts per quarter)
• CAPS for CCOs
• Compliance feedback and education
• Conducts all AUDITS for TEAMonitor, this position leads TEAMonitor efforts.
Training & Network Support
• Training to entire CCO network on HIP, Wellpoint Documentation and ongoing needs for program (Network consists of 200 CCs)
• Training and Technical Assistance to CCO network which includes monthly meetings with each CCO and Ad Hoc meetings and trainings as necessary
• HIP inbox monitoring and assistance
• Training to Health Home Supervisors
Monitoring & Tracking
• Monitors Health Homes CCs caseloads
• Monitors CCs due diligence reports
• Tracking of audits, documentation performance, claims, engagement rates, and monthly assignments
• Eligibility File Reviews Quarterly for each CCO (involves manual look up of CCO assignment list for enrollee status)
• Uploads and monitoring of consents to HIP
• Tier 2 Exception approvals, tracking, and reporting to the state (TEAMonitor requirement)
Communication & Coordination
• Communication to CCO network on new processes and roll out of new programs, contract changes, etc
• Incident Report response and communication with HCA
• Justice Support Team Collaboration