Coordinate and monitor the clinical and funding eligibility of substance abuse treatment services funded by the BHSI Program to its target population.
Duties and Responsibilities:
Receive referrals and determine client eligibility for Program services.
Review clinical assessment information for determination of the appropriate level of care based on the Pennsylvania Client Placement Criteria (PCPC).
Approve and authorize treatment services at all levels of care or refer to more clinically appropriate services.
Carry caseload of Provider Agencies and act as the liaison and primary contact to those agencies.
Review the results of the PCPC as it pertains to continue stay requests for treatment.
Reauthorize the continuation of treatment or recommend and facilitate necessary changes in levels of care.
Conduct telephone utilization reviews with Provider staff on continued stay requests received.
Perform on-site utilization review activities, as needed which may include, but not limited to the review of client charts, documentation of treatment services, completion of required paperwork, confirmation of attempt to establish M.A. eligibility.
Perform assessments as required.
Monitor Program eligibility of active patients via the Department of Welfares MAMIS system. Document and notify Providers of changes.
Ensure all required patient paperwork is received and complete, including discharge information.
Enter and track patients in the Programs Management Information System, which includes generating the treatment authorizations resulting in Provider payment.
Complete all documentation in patient records as required.
Assign, log and communicate approval numbers and denials to providers.
Other duties as assigned.
Good clinical and diagnostic skills, written and verbal communication skills; decision making skills; computer management information system and data entry skills essential. Must be detail oriented.
PMHCC - 20 months ago