Clinical Specialist - Self-Determination

Clinical Specialist—Self-Determination

Under the direct supervision of the I/DD Program Administrator and general supervision of the Director of Utilization Management, the Self-Determination Specialist will ensure that DWIHN and its provider network observes state and local Self-Determination policies, standards, rules and regulations to support individuals with an intellectual/developmental disability, serious mental illness, and/or co-occurring disorders.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Supports the Person-Centered Planning process by implementing the operational tasks for individuals who Self-Direct their services.
• Participate in the development of the Individual Budget process.
• Ensure that the components identified by MDHHS regarding Self-Directing services are in place for each individual who Self-Directs their services.
• Ensure the Person-Centered Planning process is followed.
• Ensure authorizations are supported in the Individual Plan of Service, agreements are in place, and an individual budget is developed.
• Serves as the primary contact for Clinically Responsible Service Providers for Self-Determination.
• Serve as an agency expert about Self-Determination and Self-Directing services for internal staff, network providers, families, and stakeholders.
• Ensure authorizations and budgets are equitable to meet the needs of all individuals who receive services.
• Ensures Medicaid is the payor of last resort by verifying that entitlements, community resources, and natural supports are exhausted prior to approving authorizations.
• Ensure timely dispositions for all service authorization requests, including denials and appeals.
• Verifies current standardized assessments depending on disability designation (e.g., LOCUS, Michi
  
  CANS, CAFAS, PECFAS).
• Utilizes Clinical Practice Guidelines and the content of the Service Utilization Guidelines to inform decisions.
• Coordinates with the Utilization Manager for the Habilitation Supports Waiver (HSW) to provide the names of individuals who may benefit from the HSW.
• Collaborates with the Program Administrator to establish training and measurable quality improvement markers for the Person-Centered Planning process, especially targeting goal development.
• Facilitates monthly meetings with Clinically Responsible Service Providers to discuss operational processes, barriers, or updates to ensure ongoing quality improvement.
• Establishes a monthly review process to ensure IPOSs are not missing signatures.
• Educates and trains DWIHN internal staff and external network providers on the Principles of Self-Determination.
• Works in conjunction with other DWIHN departments and various work groups or special projects to improve agency efficiency.
• Contributes knowledge and experience to identify system barriers and develop process improvements.
• Serves as one of the liaisons to the Financial Management Service agencies.
• Works in conjunction with the Financial Management Service Coordinator to maintain quality and efficiency for individuals who Self-Direct services.
• Performs data gathering, documentation, and analysis for desired outcomes.
• Tracks and monitors cost factors relative to service utilization, treatment activities, and other criteria.
• Monitors provider services for adherence to priority Federal, State, and Medicaid admission requirements.
• Performs related duties as assigned.

Knowledge, Skills, and Abilities (KSAs):

• Knowledge of Self-Determination, Self-Directing Services, Person-Centered Planning, Home and Community-Based Services, and NCQA standards.
• Knowledge of MDHHS’ Self-Determination and Person-Centered Planning policies.
• Knowledge of PIHP/CMHSP encounter reporting.
• Knowledge of HCPCS and Revenue Codes.
• Knowledge of the Medicaid definitions for the most frequently used Self-Directed services, Community Living Supports, and Respite.
• 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 the clinical care process (screening, assessment, treatment planning, case management, and continuing care).
• Knowledge of and…