Clinical Specialist Monitor

Overview

CLINICAL SPECIALIST - PERFORMANCE MONITOR Under the general supervision of the Quality Administrator, Performance Monitoring, the Performance Monitor staff is responsible for conducting on-site reviews of providers and ensuring their compliance with quality and performance standards among contracted Substance Use Disorder (SUD) treatment providers. This role emphasizes monitoring provider adherence to regulatory requirements, contractual obligations, and evidence-based practices to improve outcomes for individuals receiving SUD services.

• Monitor SUD providers for compliance with state, federal, and organizational regulations.
• Review provider documentation, billing practices, and service delivery for accuracy and integrity.
• Conduct audits and site visits as required.
• Track provider performance metrics, including treatment outcomes, timeliness, and member satisfaction.
• Identify gaps in service quality and collaborate with providers to implement corrective action plans.
• Ensure adherence to evidence-based treatment protocols.
• Collect and analyze data related to provider performance and compliance.
• Prepare reports for leadership summarizing findings, trends, and recommendations.
• Maintain accurate records of monitoring activities.
• Serve as a liaison between providers and internal departments to resolve issues.
• Provide technical assistance and training to providers on compliance and quality standards.
• Support continuous improvement initiatives across the SUD provider network.
• Design systems and procedures.
• Conduct work simplification and measurement studies.
• Prepare operations and procedures manuals.
• Set standards, conduct performance assessments, and conduct remote and on-site monitoring of providers in the network.
• Monitor the facility quality improvement process and provide facility provider education and oversight.
• Participate in MDHHS audits and site visits.
• Oversee new program enrollment and Medicaid enrollment reviews, including site visits to ensure that new programs or programs requiring Medicaid enrollment meet minimum participation requirements in the DWIHN network.
• Attend SUD and other provider meetings.
• Review data for trends and create monthly reporting, including reporting data into the Cascade software database.
• Communicate with providers by responding to phone calls, responding to e-mail requests, providing training, and providing technical assistance.
• Performs related duties as assigned.

• Knowledge of DWIHN policies, procedures, and practices.
• Knowledge of the principles of quality improvement.
• Knowledge of Utilization Management.
• Knowledge of Quality Assurance.
• Knowledge of the DWIHN provider network.
• Knowledge of medical, behavioral health, and SUD practices and terminology.
• Knowledge of compliance standards.
• Knowledge of the evidence-based practices for prevention, treatment, and recovery support services for mental and substance use disorders.
• Knowledge of MDHHS policies, rules, regulations, and procedures.
• Knowledge of Medicaid policies, rules, regulations, and procedures.
• Knowledge of the NCQA accreditation process.
• Knowledge of HSAG annual compliance reviews.
• Knowledge of Integrated Care principles and practices.
• Knowledge of Health and Safety and Claims Investigations.
• Knowledge of Behavior Treatment Plans, IPOS, Medication Administration, and Incident reporting.
• Assessment skills.
• Organizational skills.
• Planning skills.
• Analytical skills.
• Report writing skills.
• Decision-making skills.
• Interpersonal skills.
• Communication skills.
• Teaching skills.
• Training skills.
• Coordination skills.
• Written communication skills.
• Investigation skills.
• Computer skills (Word, Excel, Access, PowerPoint, Outlook, Teams).
• Teamwork skills.
• Ability to communicate orally.
• Ability to communicate in writing.
• Ability to work effectively with others.
• Ability to work with an ethnically, linguistically, culturally, economically, and socially diverse population.
• Judgement/Reasoning ability.

A master’s degree in social work, Psychology, Counseling, Nursing (a bachelor’s degree will be accepted), or a related field.

State of Michigan license…