Coordinates integration of care between behavioral health and primary care providers. Reviews, records, corrects and, monitors clinical documentation of community based behavioral health treatment to ensure compliance with established organization and managed care company policies, standards and requirements. Assists clinical staff in engaging clients in primary and behavioral health treatment. Provides direct support to clients and parents/guardians in the assessment process including: completing registrations, taking histories, reviewing clinical documentation, determining appropriate servicing clinician, interpreting insurance coverage, scheduling appointments and assisting clients and parent/guardians in removing barriers to attendance at appointments. Frequently interfaces with medical providers to ensure coordination of care among multiple healthcare systems. Ensures documentation is entered in clients’ records in a timely manner and reflects services provided by internal and external providers.
DISTINGUISHING ELEMENTS OF THE CLASS:
- IMPACT: Compliance with agency, accrediting and managed care company documentation standards is required to assure continued accreditation, licensure, and payment for rendered services by governmental and non-governmental payers. Incumbent’s efforts to engage/re-engage clients in treatment may have a significant effect on therapeutic outcome. This class is responsible for assisting new and renewing clients and parent/guardians through the assessment process and ensuring assessment data is accurately recorded and collected. The accurate, timely and appropriate response to clients and parents/guardians reduces barriers to care and maximizes use of clinical time for treatment. This class is also responsible for ensuring that data is collected from external healthcare providers and properly entered into the electronic health record and for ensuring follow-up on medical conditions as necessary.
II. LATITUDE: Assignments are performed with regular consultation follow-up from the Manager. Work is guided by detailed program and agency policies, guidelines and instructions. Most administrative and technical matters are handled independently. The Supervisor is available for assistance in decisions concerning customer complaints, complex insurance and documentation issues. Interpretation and application guidance is available and provided by the supervisor and agency quality management administrators.
III. RESPONSIBILITY FOR THE WORK OF OTHERS: None.
IV. INTERPERSONAL CONTACT: Continuous contact with physicians, nurses, clinicians and other staff in collecting, recording, reviewing and correcting clinical documentation. Daily contact with clients and parent/guardians both face-to-face and by telephone to gather clinical history and presenting problem information. Continuous contact with clients, family members, and referral sources (such as social workers, psychiatrists, juvenile court officials and police, teachers and foster families) to facilitate assessments, follow up on missed therapeutic sessions, follow up on primary care appointments, minimize barriers to client attendance at scheduled appointments and engage clients in treatment.
V. DIFFICULTY: Incumbent must deal with a variety of documentation requirements established by different agencies, and ensure correct standards are applied to each record. Appropriately relating together various parts of the treatment record requires an astute knowledge of underlying mental and behavioral health treatment and documentation requirements. Work also involves the understanding of the type of behavioral health problems experienced by clients, understanding of the assessment process and motivation of customers to attend assessments by minimizing barriers to care. On-going administrative and technical tasks require accuracy, attention to detail and an in-depth degree of understanding of insurance coverage and clinician capabilities and availability. Frequent communication with external providers is required and may result in follow-up phone calls and ongoing efforts to ensure follow-up on outstanding requests and issues.
VI. COMMUNICATIONS: Client contacts require careful and client-sensitive communications by phone, in person and by mail. Contacts with other clinicians require tactful approach to ensure clinician cooperation. Frequent interaction with external providers requires tactful and sensitive communication in person and by phone.
VII. EQUIPMENT/FACILITIES RESPONSIBILITY: None.
VIII. WORKING CONDITIONS: Work is performed in a clinical outpatient setting. May require travel to community doctors’ offices to obtain pertinent information for client records.
IX. KNOWLEDGE, SKILLS AND ABILITIES (KSA’S)
- Knowledge of medical conditions and side effects of psychotropic medications
- Knowledge of licensure, accrediting agency and managed care company clinical documentation requirements.
- Knowledge of the internal relationship of various parts of the clinical record.
- Good knowledge of the common treatment documentation practices.
- Good oral and written communication skills.
- Good knowledge of the laws, guidelines, and legal procedures relating to mental health care or substance abuse treatment to include HIPAA and 42 CFR.
- Good knowledge of child development inclusive of social-emotional development and practices to ensure child safety.
- Good knowledge of the impact that behavioral health, developmental needs, trauma, and environmental issues have on children, adolescents, and families.
- Good knowledge of Integrated Care for primary and behavioral health.
- Ability to establish and maintain effective relationships with staff and clients.
- Ability to recognize documentation error trends and inform clinical supervisor.
X. LICENSURE: Current and valid State Licensure as a Licensed Practical Nurse from the Virginia State Board of Nursing. Valid Virginia Driver’s License.
XI. PRINCIPAL DUTIES AND RESPONSIBILITIES OF CLASS (ILLUSTRATIVE ONLY)
- Communicate with physician offices for the purposes of coordination as it relates to integrated primary and behavioral health care, and to secure primary care screening information for clients.
- Review primary care screening information, make treatment recommendations, and make referrals as appropriate.
- Record services and primary screening data elements in electronic health record.
- Works with children and families with behavioral health and developmental needs.
- Reviews clinical documentation for compliance with program, licensure, accrediting agency, and managed care company documentation standards.
- Notifies clinical staff of documentation discrepancies which cannot be corrected by incumbent.
- Corrects clinical documentation discrepancies within capabilities and guidelines.
- Assists clinicians in maintaining a complete, accurate clinical record.
- Supports clients and parent/guardians by completing intake paperwork to include taking histories, reviewing clinical documentation, and explaining program rules and guidelines for treatment. This function will be complete either on the phone or in person.
- Good knowledge of the laws, guidelines, and legal procedures relating to mental health care or substance abuse treatment to include HIPAA and 42 CFR Part 2.
- Assist client and parent/guardian in removing barriers to attendance at appointments through timely scheduling, assignment to the appropriate clinician and telephone reminders.
- Initiates contact with clients and referral sources to re-engage clients in treatment after missed appointments.
- Maintain License as Practical Nurse under the Virginia Department of Health Professions.
- Does related work as required .
XII. PHYSICAL REQUIREMENTS: Must have the use of sensory skills in order to effectively communicate and interact with other employees and the public through the use of the telephone and personal contact as normally defined by the ability to see, read, talk, hear, handle or feel objects and controls. Physical capability to effectively use and operate various items of office related equipment, such as, but not limited to a, personal computer, calculator, copier, and fax machine. Some standing, walking, moving, climbing, carrying, bending, kneeling, crawling, reaching, and handling, pushing, and pulling.
XIII. DRIVING REQUIREMENTS: Valid Driver’s License. Transports agency clients as needed.
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