The Access / Call Center is the initial point of contact for members, their families, providers, and the general public for Behavioral Healthcare inquires for the twenty-county area managed by our client. Access management is a critical function of the Local Management Entity (LME) / Managed Care Organization (MCO). There are multiple lines supported by the Access/Call Center inclusive of a toll-free crisis line and a provider line. Staff supporting these lines provide information, help members access care, triage emergency calls, and network provider assistance.
The Access Clinician provides support to callers which include assisting members who are requesting mental health or substance abuse services. The Access Clinician conducts brief telephonic screening to gather demographic information, verify insurance eligibility, determine presenting clinical needs, including any immediate crisis intervention required, and determine the timeframe for establishing care based on the severity and type of need. Brief counseling and crisis intervention will be provided as needed to any callers, inclusive of crisis management. The employee will interface with other clinical and administrative staff to schedule appointments, link to appropriate resources, and connect with other teams such as the care management or member engagement teams where appropriate. Documentation of all calls following standardized protocols is expected for all inbound or outbound calls.
The Access Clinician is responsible for (though not limited to)
· Triaging calls to determine the severity of needs and appropriate connections:
§ Gather the information necessary from member, their representative or Protocol report to assess the need for MH/SUD and/or IDD services and complete enrollment.
§ Provides arrangement, linkage, and or integration of services for members in need of MH/SUD and/or IDD acute levels of care.
§ Use clinical criteria to evaluate information gathered from providers, system records or narrative information provided to make clinically sound recommendations on levels of care
§ Provide brief therapy and/or crisis intervention as needed.
§ Perform formal triage of calls to determine the urgency of the individual’s needs
§ Provide direct support to non-licensed call center staff regarding clinical areas
§ Provide members and/or their representatives with education regarding benefit structures, verification of benefits and information about managed care system.
§ Refer member to appropriate network providers to meet clinical and geographic needs, including immediate linkage to mobile crisis providers when indicated
§ Link members to alternative community resources when appropriate based on the presenting needs identified.
§ Divert members from acute levels of care when clinically appropriate to avoid unnecessary emergency room visits or inpatient stays
§ Generate referral documentation for the transmission to appropriate providers for provision of treatment and ensuring payment for services.
§ Assure that call volume is maintained adequately to ensure quality consumer service in a timely manner.
· Maintains Call Center performance standards
§ Completes all required call documentation timely including referrals to providers or referrals to other internal business units
§ Maintains expected availability status in the call center work queues during work hours
§ Meets all expected call metrics which inclusive of average talk times, calls handled, abandon calls
§ Meets expected standards on quality audits, inclusive of but not limited to following call scripts, providing positive customer service, following standardized process/protocols for call handling
§ Demonstrates flexibility for shift coverage or schedule adjustments to meet the overall business needs of the call center determined by call volume or other identified needs
· Other duties tasks, and/or projects as assigned
Knowledge, Skills, and Abilities:
· Knowledge of Call Center practices and operations.
· Outstanding communication and interpersonal skills
· Ability to multitask and prioritize
· Ability to remain calm in stressful situations, specifically with the ability to manage behavioral health crisis events
· Ability to manage working in a fast-paced environment
· Comprehensive knowledge and experience in working with various computer programs including Microsoft Word, Excel, and electronic call center or care management systems.
· Ability to navigate multiple computer systems.
· Knowledge of clinical protocols to ensure referrals to appropriate level of care.
· Ability to identify both potential service needs and social determinant of health (SDOH) needs of callers.
· Knowledge of community resources outside of mental health; substance use disorder and developmental disability services to provide diversions to alternative care when applicable.
Required Training and Education:
Required Competencies: Therapeutic and crisis intervention experience; knowledge of available resources within the served catchment areas.
Required Minimum Training:
Master’s Degree in Social Work or related field and two years post-licensure experience in a Mental Health, Intellectual Disability / Developmental Disability and/or Substance Abuse setting. Requires a current North Carolina Clinical License.
Knowledge of Call Center operations preferred but not required. Knowledge of the most current version of the DSM for preliminary diagnosis. Knowledge of standardized level of care tools such as but not limited to CALOCUS / LOCUS and ASAM criteria.
Accuracy Required in Work
All work requires the highest possible accuracy to ensure members and customers receive quality care in a timely manner.
Consequence of Error
Inefficiencies in the Call Center process could result in members not receiving quality care that could result in negative outcomes. Errors in determining level of need could result in consumer receiving the wrong level of care, which could result in ineffective treatment for the consumer.
This is a remote-based position where the employee will work in a home office that meets all requirements to ensure privacy of HIPPA information. Minimal travel to other locations being required, which may include working from the office-based on any technology issues or problems that may arise. The employee is also expected to come into the office for meetings, trainings, or other events. Staff is obligated to fulfill the shifts for which they agree to cover and following appropriate protocols for unexpected events such as illness or emergency. The Call Center leadership must set priorities to maintain adequate call center coverage, and meet the schedule needs of the business.
Holidays, and coverage for shifts outside of the normal schedule may be requested by the Manager or designee to meet the needs of the department. Staff must have high-speed internet access meeting the business requirements and have a dedicated office space to work from.
Though staff are virtual, they must operate like a 24/7 call center, being present on the phones, and in queue, to answer multiple, consecutive calls during the duration of the assigned shift. This position requires long hours of sitting and performing data work in front of a computer.