Responsible for receiving and monitoring information related to provider quality assurance issues including but not limited to grievances, quality of care concerns, and incidents. Effectively writing reports and documentation to ensure issues and reports are available for analysis and action in keeping with state mandates. Use of current data systems to extrapolate data necessary for department and agency reports. Reviewing and tracking corrective actions taken by the network providers to address concerns which may be used for monitoring and review purposes. Working closely across departments regarding findings. Reporting to various state licensing agencies.

Monitoring and assuring that assessments, person-centered plans discharge plans,and crisis plans are complete and available for review. Assisting by addressing additional support services and community resources needed by individuals experiencing mental health/ substance use disorders. Identifying barriers to support services and resources including linkage to appropriate provider agencies within the network. Monitoring outpatient commitments. Coordinating care with various stakeholders involved in member care across the MCO and with other systems, including primary care providers. Tracking individuals discharged from state hospitals to assure follow up with aftercare services and receive assistance needed to prevent other hospitalizations.

Responsible for provider adherence to Managed Care Organization rules and guidelines to ensure sufficient, safe and effective services are being provided to consumers who have been identified as having Mental Health, Developmental Disabilities or Substance Abuse needs. Provide training, education and support to providers. Conduct routine monitoring and investigations to resolve incidents, violations and other gross misuse of Federal funds.

Monitor services of licensed and unlicensed mental health, developmental disability and substance abuse providers for quality of care provision.

Responsible for an active caseload of adults with mental health and/or substance abuse diagnoses. Provided coordination across levels of care, directly to the consumer and their families.