PartnersACCESS Specialist (QP)-Remote-NC (PRN)
About the 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. Responsibilities • 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 • Assist 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 • Complete screenings using standard and specialized computer programs • Input accurate information into the system and unlock 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 • Establish and maintain effective working relationships within the unit, agency, and service system • 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 Requirements • Bachelor's Degree in related field or Licensed Practical Nurse (LPN) and at least two (2) years of healthcare or MH/SU/IDD experience • Sound knowledge of health/MH/SU/TBI/I/DD for the appropriate determination of eligibility for Medicaid and State supported services • Knowledge of the laws governing the treatment of health, mental illness, substance abuse and intellectual/developmental disabilities • 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 • Ability to communicate effectively orally and in writing, have good keyboarding skills and be able to multi-task • 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 Nice-to-haves • Licensed practical nurses (LPNs) and at least four (4) years of healthcare and/or MH/SU/IDD experience Benefits • PRN position - not eligible for benefits Apply tot his job