Clinical Specialist - Adult Initiatives

Job Title

Clinical Specialist - Adult Initiatives 

Department

Adult Initiatives 

Reporting Structure

Director of Adult Initiatives 

Pay Grade/Salary

08

Exempt/Non-Exempt

Exempt

Bargaining Unit:

Yes

Work Location

Varies

Employment Status (FTE)

Full-Time 1.0

Standard Hours 40

Job Summary

Under the supervision of the Director of Adult Initiatives or Administrator, the Clinical Specialist is responsible for providing monitoring and oversight of clinical services delivered by the Detroit Wayne Integrated Health Network (DWIHN) network of contracted providers. The Clinical Specialist will ensure that the implementation of physical and behavioral health services is delivered in line with DWIHN and MDHHS contractual obligations. The Clinical Specialist will function as part of a multi-disciplinary team to ensure beneficiaries receive the appropriate service provisions based on the clinically appropriate level of care. This position will primarily focus on, but is not limited to, the Clubhouse and Evidence-Based Supported Employment (EBSE) programs.

NOTE: (This position works in the Clinical and Practice Improvement Department)

Essential Duties & Responsibilities

• Administration & Support

  • Develops and maintains policies and procedures in accordance with Michigan Department of Health and Human Services (MDHHS) requirements and program fidelity standards for Clubhouse and Evidence-Based Supported Employment (EBSE) programs.
  • Provides education, training, and technical assistance to network providers and contractors regarding applicable policies, procedures, standards, and service requirements.
  • Coordinates and facilitates recurring meetings with Clinically Responsible Service Providers (CRSPs) to ensure effective communication, service utilization, and reporting compliance.
  • Ensures compliance with Health Insurance Portability and Accountability Act (HIPAA) requirements related to the submission and management of member data.
  • Performs other related duties as assigned.

  Customer & Stakeholder Engagement

  • Collaborates with the Customer Services Department and provider network to address and resolve member satisfaction concerns.
  • Works with Recipient Rights to address grievances, appeals, denials, and related member issues.
  • Facilitates and attends stakeholder meetings, community forums, and educational sessions to provide updates, training, and information regarding network policies and procedures.
  • Partners with the Adult Initiatives Director (or Administrator) to evaluate and improve member satisfaction related to service delivery.
  • Collaborates with the Access and Call Center to review eligibility criteria, disability designations, service referrals, and coordination of care processes.

  Project & Program Management

  • Provides clinical oversight of contracts with Clinically Responsible Service Providers (CRSPs) and oversees the implementation of integrated physical and behavioral health services across the DWIHN provider network.
  • Oversees accredited psychosocial rehabilitation programs (Clubhouse) throughout the network ensuring adherence to regulatory and fidelity standards.
  • Oversees Evidence-Based Supported Employment (EBSE) programs throughout the provider network ensuring adherence to regulatory and fidelity standards.
  • Monitors program performance, utilization trends, and service outcomes to identify opportunities for improvement and ensure compliance with organizational standards.
  • Collaborates with the Quality Department to support network adequacy initiatives and develop Performance Improvement Plans (PIPs) related to audits, accreditation reviews, and quality improvement efforts.
  • Partners with the Integrated Health team to advance physical health integration initiatives across the provider network.

  Technical / Professional Skills

  • Develops, analyzes, and interprets clinical and operational reports to identify utilization patterns, service trends, performance gaps, and opportunities for improvement.
  • Uses data-driven decision-making to develop corrective action plans and performance improvement strategies for providers who do not meet established standards.
  • Provides technical consultation, guidance, and monitoring to CRSPs regarding access to care, service coordination, utilization management, and compliance requirements.
  • Ensures implementation and ongoing monitoring of evidence-based and best practice models, maintaining program fidelity and quality standards.
  • Participates in multidisciplinary teams to evaluate service needs and ensure individuals receive clinically appropriate levels of care.

  Industry-Specific Duties

  • Provides clinical leadership and oversight for behavioral health and integrated care initiatives within the Detroit Wayne Integrated Health Network (DWIHN) provider system.
  • Ensures Clubhouse and Evidence-Based Supported Employment (EBSE) programs operate in accordance with MDHHS requirements, accreditation standards, and fidelity model expectations.
  • Supports clinical oversight activities related to access, coordination, and delivery of behavioral health and rehabilitation services.
  • Collaborates with internal departments and contracted providers to ensure compliance with accreditation, audit, quality management, and behavioral health service standards.
  Promotes person-centered service delivery and continuous quality improvement across the behavioral health provider network.

KNOWLEDGE, SKILLS AND ABILITIES (KSA’S):

• Knowledge of DWIHN policies, procedures and practices.
• Knowledge of the DWIHN provider network and community resources.
• Knowledge of the Michigan Mental Health Code.
• Knowledge of MDHHS policies, rules, regulations and procedures.
• Knowledge of medical and behavioral health practices and terminology.
• Knowledge of compliance standards.
   Knowledge of documents / regulations that govern the provision of mental health services, e.g., Medicaid Manual Mental Health and Substance Abuse Chapter III, State Plan for Medicaid, Michigan Department of Health and Human Services Quality Plan, BBA requirements and the Mental Health Code.
• Knowledge of the practices and principles of psychological, emotional, and sociological assessment and diagnosis.
• Knowledge of regulatory and industry best practice standards.
• Knowledge of Community Mental Health Services Programs (CMHSP) and Prepaid Inpatient Health Plans (PIHP).
• Knowledge of Integrated Care practices and principles.
• Knowledge of and ability to use multiple technology systems.
• Knowledge of HAB Waiver and HAB Waiver requirements.
• Knowledge of the adult I/DD provider network.
• Knowledge of the continuum of care for all disability designations (I/DD SED, SMI, Co-Occurring Disorder).
• Computer skills
• Time management skills
• Organizational skills
• Critical thinking skills
• Teamwork skills.
• Conflict Resolution skills
• Problem-Solving skills
• Decision Making skills
• Negotiation skills
• Project Management skills
• Assessment skills
• Report writing skills
• Communication skills
• Multitasking skills
• Analytical skills
• Adaptability skills
• Interpersonal skills
• Teamwork skills
• Ability to communicate orally.
• Ability to communicate in writing.
• Ability to work effectively with others.
• Ability to work with an ethnically, linguistically, culturally, economically and socially diverse population.
• Judgement/Reasoning ability

Required Education & Experience:

REQUIRED EDUCATION

REQUIRED EXPERIENCE

Experience must include:

Experience providing services to children and adults with severe emotional disturbance, children and adults with intellectual and or developmental disabilities, adults with mental illness and/or individuals with substance use disorders.

Required License(s)/Certifications

WORKING CONDITIONS:

Work is usually performed in an office setting but requires the employee to drive to different sites throughout Wayne County and the State of Michigan.

This description is intended to provide a general overview of essential job functions and responsibilities. It is not an exhaustive list. Management reserves the right to modify the position at any time.

EEOC Statement

DWIHN is an Equal Employment Opportunity Employer committed to fair, consistent, and merit-based hiring practices. All qualified applicants are considered for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, marital status, veteran status, sexual orientation, gender identity, or any other status protected under applicable federal, state, local law.

Employment decisions are based solely on job-related qualifications, demonstrated competencies, and organizational needs. DWIHN maintains policies and procedures designed to ensure that recruitment, selection, promotion and all other employment actions are conducted in a manner that is objective, equitable and non-discriminatory.