Substance Use Disorder Care Coordinator
The Substance Use Disorder Care Coordinator is directly responsible for implementing a care coordination program that focuses on improving the substance use health status of individual PrimeWest Health members and their communities while reducing health care costs through coordinating substance use and wellness services provided by PrimeWest Health’s contracted health care and human service providers.
- Reporting Accountability
This position is responsible for meeting the following regulatory, contractual, or other requirements on behalf of PrimeWest Health:
- Knowledge of Minnesota Department of Human Services (DHS), Centers for Medicare & Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA) requirements
- Knowledge of the following DHS programs and contracts: Families and Children (F&C), Special Needs BasicCare (SNBC), and Minnesota Senior Health Options (MSHO)/Minnesota Senior Care Plus (MSC+)
- Role and Key Responsibilities
Assist the Care Management department and other PrimeWest Health staff in the following as needed:
- Essential Functions and Responsibilities
- Assess the individual and aggregate substance use status of members
- Coordinate individual member treatment plans with a multi-disciplinary team that ensures appropriateness, quality, and cost-effectiveness of services provided to members
- Monitor effectiveness of treatment plans
- Collaborate with county agencies in achieving community substance use improvement goals
- Assist in fully implementing the PrimeWest Health care management model
- Conduct care management/substance use education training sessions
- Implement the care management model through telecommunication and direct interaction
- Assist in developing and implementing continuous substance use care coordination and quality improvement plans
- Conduct monthly monitoring with follow-up regarding utilization management pertinent to substance use health
- Staff appropriate committees as assigned
- Essential Functions and Responsibilities Related to this Care Coordination Position
Assist the Care Management department and other PrimeWest Health staff in the following:
- Develop and implement the Substance Use Education Program for members
- Collaborate with other care coordinators and member services and provider services staff
- Demonstrate knowledge of Quality Improvement Process and data interpretation
- Attend and collaborate with community, regional, and state-wide initiatives as they relate to substance use disorders
- Participate in PrimeWest Health substance use disorder initiatives, substance use collaboratives, and local advisory committees when requested
- Assist members with accessing treatment, outcomes, discharge planning, and post-discharge follow-up. In addition, provide support and education to members post-discharge to encourage healthy lifestyles and referrals for additional services when needed.
- Provide member and provider notification/education, including updating the PrimeWest Health Provider Manual
- Perform utilization management intake responsibilities on all Service Authorization requirements and denials, terminations, and reductions in services for substance use, including review and approval of Rule 25 assessments, inpatient treatment, residential treatment, outpatient treatment, and medication-assisted therapy
- Perform quality and compliance audits as required for targeted case management and substance use treatment providers based on MN Statute 254A and 254B, Title 42 Code of Federal Regulations (CFR), MN Rule 9530, and NCQA standards
- Develop, monitor, and update appropriate PrimeWest Health policies and procedures
- General PrimeWest Health Responsibilities
- Abide by the PrimeWest Health Code of Conduct
- Comply with all PrimeWest Health policies and procedures
- Comply with the Health Insurance Portability and Accountability Act (HIPAA) and all other privacy laws
- Be familiar with building safety procedures and alert maintenance if something requires attention
- Keep public areas of the department and office neat and clean
- Conduct other responsibilities and activities as needed and assigned
- Professional Competencies
- Practice knowledge of clinical standard and outcomes
- Collaborative abilities
- Written and oral communication abilities
- Organizational and time management skills; ability to work effectively with minimal supervision and structure
- Educational Requirements and Required Qualifications
- At minimum, a BS/MS with preferred expertise in assigned area of responsibility. Must have current/prior knowledge of working with waiver services and county structure related to this population.
- Demonstrated knowledge of, and proficiency in, Word, Excel, and Outlook required.
- Flexibility and ability to handle multiple tasks. Demonstrated organizational skills and attention to detail. Ability to work effectively with a variety of people both within and outside of the organization. Excellent verbal and written communication skills.
- Ability to sit at a desk or computer station most of the time. Ability to occasionally lift and/or carry such articles as file folders and small boxes up to 30 pounds. Some travel including overnight travel required.
- Appropriate Licensure and Certification Requirements
- Current and unrestricted alcohol and drug counselor license preferred
- Current and unrestricted alcohol and drug counselor Minnesota certification preferred
- Registered nurse (RN) license in the State of Minnesota with current registered nurse (RN) license in the State of Minnesota considered, and must have at least 1 year of experience working with individuals with substance use disorders
- Must attend continuing education sessions each year to support license requirement
- Collaborative Efforts with Other Departments
- Administrative Services
- Information Systems & Technology
- Membership & Program Development
- Provider Network Administration
- Quality & Utilization Management
- Supervision N/A
This position description is not to be construed as an exhaustive statement of essential functions or responsibilities.
PrimeWest Health will accept resumes for this position through May 11, 2018. No phone inquiries please. Employment to begin ASAP.
Select one of the options below:
Qualified candidates should submit their resume and cover letter to:
Elaine Carlquist, Director of Care Management
3905 Dakota St
Alexandria, MN 56308
Please include “Employment Ad” in the subject line.