Quality Assurance Coordinator/Case Manager

SUMMARY

 Assists the QA Program in auditing charts and ensuring data is furnished to the appropriate channels in a timely manner. Ensures compliance of documentation with external funding certification agencies and Red Rock policies and procedures. Ensure implementation of the comprehensive care plan, which will include mental health goals, physical health goals, and other life domain goals for achievement of clinical outcomes consistent with the needs and preferences of the member. Case Managers interact regularly with other staff, including the Health Team, and treatment providers to assess and treat individuals with mental, emotional, or substance abuse problems, including abuse of alcohol tobacco, and/or other drugs.  Activities may include crisis intervention, case management, treatment planning, client advocacy, prevention and education.  As part of the Health Team, the Behavioral Health Case Manager I-Level I may provide ongoing service coordination and link members to resources following appropriate training.

 ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

•  Follows guidelines and ensures compliance of clinical records for TXIX, ODMHSAS, CARF and other funding sources or regulatory agencies.
• Reviews clinical records for funding source and accreditation standards and collaborates with staff to correct charts and educate on compliance requirements.
• Holds office hours for staff and serves as a local resource for staff. 
• Provides hands on training for staff as needed.
• Ensure clinical knowledge is current.
• Works with QA Program Director to ensure QA Program Goals are being met.
• Assists in data collection and ensures data is appropriately tracked and furnished to Data Analyst.
• Attends staff meetings, workshops and seminars to learn agency policies, rules, regulations, and procedures; participates in ongoing in-service training as well as pertinent external training. 
• Maintain knowledge of programmatic goals and objectives.
• Continues to perform in their clinical role on site.
• Performs other duties as assigned.

• Maintains core competencies in relation to working with co-occurring disorders through continuing education and implementing skills into all aspects of treatment

• Provides practical help and support, advocacy, coordination, side-by-side individualized support, problem solving, direct assistance, training, and supervision to help consumers obtain the necessities of daily living including medical and dental health care; legal and advocacy services; financial support such as entitlements (e.g., adult foster care, paid roommates, meals brought in for those who need it); money-management services (e.g., payeeships); and transportation
• Participates in disposition/treatment team meetings, providing the information is pertinent to the treatment of the consumer
• Assists in developing, writing, implementing, evaluating, and revising overall Service Plan goals and objectives
• Coordinates approved services, facilitates communication between various service providers with Department of Human Services (DHS) or other referral sources; advocates on behalf of each consumer to ensure that treatment and reintegration plans are being followed, and assists the consumer, family, and referral source in arranging follow up support services
• Educates and supports consumers’ families
• Assists each consumer in having Primary Care services and supports consumers to have and effectively use a personal physician and dentist. Assists consumers in learning self-management skills for their physical health concerns. Addresses and reminds consumers of preventive care as recommended by their physician 
• Provides and completes all paper work assignments and prior authorizations, including but not limited to Service plans, Consumer Assessment Records and daily progress notes within designated time frame
• Documents consumer progress to maintain a permanent record of consumer activity according to established methods and procedures
• Provides ongoing assessment of consumers’ mental illness symptoms and consumers’ response to treatment.  Makes appropriate changes in treatment plans to ensure immediate and appropriate interventions are provided in response to changes in mental status or behavior which puts consumers at risk (e.g., suicidality)
• Demonstrates knowledge of requirements and compliance with Medicaid, Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS), Commission on Accreditation of Rehabilitation Facilities (CARF) and any other funding/contract source
• Exhibits knowledge of core competencies in relation to working with co-occurring disorders through continuing education and implementing skills into all aspects of treatment
• Demonstrates confidentiality and informs consumers of rights and obtains necessary authorization for obtaining and releasing information
• Assures coverage when co-workers are absent by filling in as needed
• Provides direct clinical services to consumers on an individual, group, and family basis in the office and in community settings to teach behavioral symptom-management techniques to alleviate and manage symptoms not reduced by medication and to promote person growth and development by assisting consumers to adapt to and cope with internal and external stresses
• Coordinates with outside inpatient services to detoxify consumers and establish linkage to self-help programs (e.g., Alcoholics Anonymous, Narcotics Anonymous) and residential facilities
• Builds rapport and working partnerships with relevant local, state, and federal government agencies
• Promotes community education projects to help increase awareness of Post Traumatic Stress Disorder (PTSD) & Acute Mental Health Crises
• Supports and assists with the facilitation of Care Plans for consumers within the Red Rock Health Team
• Performs other duties as assigned

 QUALIFICATIONS

• Certified as a Behavioral Health Case Manager I (BHCM I)

• High School Diploma 
• Bilingual preferred
• General skill in exercising independent judgment, tact, patience, and understanding; maintaining effective working relationships and strategic alliances with consumers, other staff, the community and other non-profit organizations
• Must complete all in-service and external training requirements 
• Basic computer skills

• Valid Oklahoma Driver License, a clean Motor Vehicle Record, and current Auto Insurance
• Two or more years experience working with community services and health agencies as well as working with low income and minority consumers with understanding of cultural diversity preferred
• Commitment to the mission of Red Rock BHS

 PHYSICAL REQUIREMENTS

• Must have the ability to stand or sit for long periods of time
• Ability to travel approximately 10% of time, if PACT travel approximately 75% of time
• Ability to use telephone, PC, fax machine, copy machine, and printer