Provider Oversight Clinical Liaison - QUEST at Wailuku

Job Description

Job Description:  

The Provider Oversight Clinical Liaison  is responsible for overseeing and monitoring external case management agencies providing SMI case management services to the QUEST population and to ensure compliance with program requirements, goals and protocol.  This position may also carry a small caseload.

 

General Competencies:

Works under minimal supervision and relies on significant experience and the exercise of judgment in the application of knowledge to the solution of difficult tasks.  Consults with Manager on the more difficult and complex issues.

Job Requirements

Skills:

A minimum of 3-5 years combined direct behavioral health, supervisory and/or managed care experience required. Leadership skills and supervisory experience, including the ability to develop team performance and vendor management a plus.  Excellent written and oral communication skills.  Self-motivated, able to prioritize multiple issues, excellent organizational skills, ability to track multiple projects/tasks and follow through as needed. Advanced level of PC skills required.

Responsibilities:

Perform weekly active outreach with assigned agencies to ensure compliance with contract, that program guidelines are being followed and, criteria are being met.

Quality oversight of completed assessments and care planning, including review of level of care decision making. 

Ensure members are being seen as per required acuity standards and documentation (pre-authorization requests, encounter filing, etc) are completed accurately and timely.

Re-evaluate acuity assignments and intervention outcomes to assure care plan goals are being met.

Monitor compliance with agreed upon quality initiatives and performance standards; assure related reports and support are developed and accurately reported.

Assist and collaborate regarding interventions and identified barriers to treatment.

Participate in development of product design and modification of workflows and program materials.

Work collaboratively with agency on member outreach, engagement and ensure consistency with program materials.

Develop monthly action plans and tracking mechanisms to demonstrate measurable success.

Assist in identification of gaps in provider and services access and recommend creative solutions.

Maintain small case load of members to ensure care needs are met and provide members with referrals and resources as needed.

Other duties as assigned.

 

Education and Licensure:

College Degree

Graduate Degree - Specific focus: Human Services Field

Current, valid and unrestricted Hawaii licensure for independent practice required with proof on date of hire. Re-verification will take place no less than every 2 years

Country: USA, State: Hawaii, City: Wailuku, Company: Beacon Health Strategies.