John Holiday Email and Phone Number

Supervise Manager of Access department that is responsible in completing eligibility determinations for speciality mental health services and assessing and authorizing substance use level of care placements. Also supervisor Quality Management, Utilization Management, and Hospital Liaison departments, consisting of 14 clinicians, one senior secretary, and one medical clerk. Oversee Quality and Utilization Management audits, inpatient prescreen authorizations and concurrent reviews, inpatient discharge planning and coordination, mental health authorization and level of care determinations, post booking jail diversion, and mental health court. Participate in Region 10 PIHP Utilization Management Committee and various workgroups.

Supervised 15 clinicians in Utilization Management and Hospital Liaison Program, plus one Senior Secretary and one Medical Clerk. Past supervisory functions also included Manager of Access in combination with Utilization Management from March 2008 until reorganization in July 2009, but continue to be back-up to Access Supervisor. The Utilization Management department is responsible for eligibility and medical necessity determination for mental health and substance use services, including prescreen for crisis services of psychiatric inpatient, crisis residential, partial hospital, and crisis stabilization programs; concurrent reviews of crisis services; and authorize mental health and substance use services and conduct outlier review audits. Liaison program is responsible for coordinating mental health and substance use services of consumers who are admitted to crisis programs, incarcerated in jail for post-booking diversion, and mental health court.In addition to direct supervision, duties include developing and implementing program policies and procedures, develop and monitor reports, organize audits, monitor program effectiveness, give presentations to network providers and community agencies, prepare and participate in Michigan Department of Health Human Services (MDHH) and Health Services Advisory Group (HSAG) audits. Participate in Medicaid Fair Hearings to support Utilization Management eligibility and medical necessity determinations.

Managed Access Center that completed eligibility determinations for specialty mental health services and substance use services. Supervised six Access Coordinators and one senior secretary. Also supervised Utilization Management and Hospital Liaison Program, which completed inpatient prescreen authorization, concurrent reviews of crisis services (inpatient, crisis residential, partial hospital, and crisis stabilization), inpatient discharge planning and coordinating, utilization management audits, mental health and substance use authorization and level of care determinations, consisting of twelve Utilization Coordinators, thee hospital liaisons, one senior secretary, and one medical clerk.

Duties include care management in relation to high-rate inpatient service utilization, concurrent reviews for psychiatric inpatient, crisis residential partial hospital, and crisis stabilization services. Authorize both mental health and substance use services, which include outpatient, case management DBT, Assertive Community Treatment, sub-acute detoxification, and residential. Completed several special projects including development of procedures for on-sight inpatient reviews; develop respite training for new employees; facilitate general fund medication formulary changes and study the impact; and introduced substance use continued stay reviews into utilization management. Other duties have included outlier audits, special consideration reviews, and eligibility reviews.

Perform case management in an intensive case management program to link and coordinate care for 64 severely and persistently mentally ill adults. Worked in an interdisciplinary team that included social workers, psychiatrist, and nurse practitioner. Developed person centered individual plans of services, crisis intervention, health assessments, storing and dispensing consumer medications, monitoring stock medications, and conducted medication reviews. Also completed direct field supervision of two social work interns that included direct consumer observations, weekly meetings, monitoring semester papers, and assessing field work and relying assessment to University of Michigan-Flint professor

Developed nursing procedure manual for crisis residential program, schedule weekend nursing staff, and facilitated monthly staff meetings. Daily functions included client intake and assessments, development of treatment plans, conducted medication reviews, crisis intervention, discharge planning and referrals, conducted continued stay reviews with utilization management, and coordinate care between case managers, psychiatrist, and primary care physicians.

Completed various nursing functions, including medication reviews, AIMS, injection, monitor consumer self-dispense medications, monitor and alert psychiatrist to laboratory results for clozapine consumers.