Deliverables/Principal Results Expected:

• Responsible for ensuring that clients with D&A problems have access to full continuum of care by identifying/assessing client needs and making the appropriate services available.


• Coordinates all appointments, aftercare plans, schedules and meetings.


• Gathers information to complete pre-certifications.


• Performs continued stay and discharge reviews on all managed care clients.


• Reviewer will look for delays in the provision of supportive services and will utilize the Medicare/Medicaid DRG length-of-stay as a guide for average length of stay.


• Reviews will be performed throughout the patient’s stay to ensure ongoing medical necessity and that treatment is provided at the correct level of care.


• Helps collect quality data including, but not limited to, denial management, avoidable days, length of stay, outliers, admits and readmissions.


• Maintain positive relationships with referral sources and insurance companies.


• Track when to complete a precert, continued stay, discharge PCPC on all county funded and MCO clients.


• Maintain an organized system of reporting to counselors when PCPC’s are due and when review calls need to be made. Maintain daily ECR data base accurately.


• Maintain and ensure proper documentation is in chart.


• Investigate cases with insurances and referral sources to recuperate any lost days of funding.


• Obtains the necessary information and releases from client, family, referral sources and other appropriate sources.


• Make referrals to Mental Health and Drug and Alcohol facilities for continuing care.


• Sets up Halfway House interviews and placements.


• Provide direct care to adults with chemical dependency problems in the 3C program, to ensure safety and well-being of these clients.


• Participate in implementing client’s treatment: maintaining communications with clients, family members and counselors.


• Accompany and transport clients as assigned.


• Orient new clients to unit and program. Teach principles and practice of the 12 Step Programs of AA and NA.


• Participate in developing life skills.


• Participates in activities which enhance professional growth and development.


• Oversee daily schedule for 3C clients.


• Provide individual sessions and educational groups and workshops.


• Schedules Family therapy appointments, reviews and coordinates treatment planning process to ensure there is follow through with Treatment Team recommendations as they relate to goals and objectives.


• Complete all documentation required for programs such as Salvation Army, Easy Does It or other programs as assigned by clinical staff. 


• Coordinate transportation needs for check cashing, ATM, St. Vincent DePaul and Salvation Army upon clinical approval.


• Provide vouchers for community resources.


• Participates in mandatory orientation and training activities. 


• Must have the ability to communicate effectively, both orally and in writing and have the ability to advocate effectively on behalf of the client.


• Other duties as assigned.

Technical Competencies:

Coordinates all aspects of treatment from financial coverage to aftercare. Overall understanding of the D&A and Mental Health field including level of care, primary funding streams, county funding structure, referral bases, managed care/private insurance knowledge. Knowledge of local, state and federal regulations. Knowledge of appeal and denial process. Knowledge of PCPC and of Release of Information and Confidentiality. Proven record of working independently, highly motivated, high degree of customer satisfaction, attention to detail/follow through. Ability to multi-task, problem solve and prioritize. Maintains professionalism and does not show favoritism. Maintains consistency with clients. Be calm and decisive in crisis situations. Flexible and adaptable. Ability to develop and sustain a team environment, very organized and detailed oriented.

Education, Experience:

High school diploma or equivalent required. Minimum of 2 -3 years in Healthcare setting, excellent interpersonal communication skills, knowledge of community and state wide referral options. Preferred

Job-related Behavioral Characteristics:

Demonstrates professionalism, leadership, confidentiality, strong social communication skills, time-management, organized. Must possess skills to communicate effectively and interact well with people of diverse backgrounds. Excellent oral and written communication and interpersonal skills. Ability to problem solve by gathering and analyzing information, working well in an individual/ group problem solving situation, and showing initiative in problem solving. Maintains professionalism and does not show favoritism. Maintains consistency with clients, staff, visitors, and the public. Ability to handle a crisis situation and react appropriately. Flexibility and adaptable. Ability to make decisions in an objective and ethical manner. Calm and decisive in crisis situations. Ability to sustain a team environment, drive continuous improvement projects, confidentiality, excellent problem-solving skills and excellent communicator within the team framework.

Pyramid CORE Values:

We are committed and proud to live our CORE values and use them to inspire those around us. Our employees are expected to align with these values, behaviors and standards. We are held accountable for upholding these CORE Values: INTEGRITY is striving to be honest, transparent and ethical when dealing with clients, staff and the community. DEDICATION is demonstrating an unwavering commitment to always provide exceptional care and support to those we serve is needed daily. COLLABORATION is a steadfast, team-focused approach; working together to achieve excellence. PASSION is genuine, compelling and relentless desire to improve lives and support Pyramid Healthcare’s mission.