The Network Improvement and Accountability Collaborative (NAIC) Clinical Consultant is responsible for conducting site visits of all funded providers in the Department of Behavioral Health & Intellectual disAbilities Services (DBHIDS) to ensure quality care is delivered, sound clinical practices are followed and regulatory requirements are met.
Duties and Responsibilities:
Conducts all aspects of NIAC site visits that includes, but is not limited to, a review of clinical files and employee files, policies/procedures, facilitation of focus groups with staff members and individuals receiving services, facility tours, Living Reviews, regulatory components in accordance with BDAP, OMH, BHSI, and/or CBH requirements, as well as newly created NIAC activities.
Performs in the role of a Team Leader; this responsibility includes, but is not limited to, acting as the point of contact for a Site Visit; organizing the assigned NIAC reviews identified; facilitating the Prep Meetings, Entrance and Exit Conferences; pulling billing to select charts; and ensuring the report is cohesive and details all meaningful information.
Educates provider staff around issues of policies and procedures and state regulations.
Forwards quality concerns to the Quality Review Department and the Consumer Satisfaction Team (CST) for referrals and resolution.
Collaborates with internal staff across DBHIDS (e.g., Contracts and Budgets to get up to date budget information prior to a Site Visit; Clinical Management regarding any clinical concerns, etc) to identify unique concerns related to specific programs and ensure appropriate internal communication.
Correlates and analyzes data acquired through the site visit process.
Prepares written reports in a timely and cohesive manner.
Identifies potentially fraudulent provider activity through clinical file reviews and focus groups with staff and individuals receiving services.
Attends regularly scheduled meetings.
Travel to provider locations, which will at times be outside of Philadelphia County.
Performs other duties as assigned.
Knowledge of the Philadelphia Behavioral Health Services Transformation Practice Guidelines for Recovery and Resilience Oriented Treatment. Understanding of diagnostic criteria and appropriate treatment approaches, clinical guidelines and best practices. Knowledge of medical necessity criteria for Pennsylvania Client Placement Criteria (PCPC) and the Adolescent Placement Criteria (ASAM). Excellent analytical skills. Proficiency in the use of Microsoft Excel and Word. Excellent writing skills and ability to summarize reports in a concise and comprehensive manner. Excellent communication skills to include presentation to large groups in a public forum. Ability to maintain professional relationships with both internal and external staff. A demonstrated ability to work cooperatively and communicate effectively, both within the Behavioral Health System and with a wide variety of individuals and agencies representing varying treatment perspectives. Ability to work independently and operate with minimal supervision in an off-site location. Knowledge about medical assistance regulations as well as knowledge of the laws, regulations, and guidelines in the behavioral health disciplines. Knowledgeable about services the provider is contracted/budgeted to provide. Knowledge of the principles and practices of administration as they apply to the promotion and coordination of programs and services within behavioral health. Ability to interpret local, state, and federal laws, regulations, and ordinances.
PMHCC - 23 months ago