Qualified Mental Health Professional/ CIS Lead

Job Summary:

The Qualified Mental Health Professional (QMHP) provides clinical leadership and program management for RYSE's Behavioral Health program. This position oversees the delivery and coordination of behavioral health services, directly supervises designated Behavioral Health staff, and provides day-to-day administrative and clinical leadership to support effective program operations.

The QMHP is responsible for supervision of assigned staff, including workload and caseload oversight, performance management, personnel matters, staff development, and ensuring adherence to organizational policies, program expectations, and applicable clinical standards. The QMHP facilitates team meetings, supports interdisciplinary coordination, provides clinical consultation, and assists staff in addressing complex participant needs and service delivery concerns.

The QMHP provides evidence-based clinical training to staff and individual and team supervision of Behavioral Health Care Coordinators. The position organizes and participates in clinical case conferences and interdisciplinary team meetings, reviews and signs off on behavioral health assessments and individualized treatment plans and provides agency-wide clinical consultation and intervention as needed.

In addition to clinical responsibilities, the QMHP supports program administration, quality assurance, data collection, contract compliance, and program evaluation. The position contributes to funding and program reports and assists with grant development and grant reporting by collecting, reviewing, interpreting, and providing relevant program data and narrative information. The QMHP works collaboratively with organizational leadership, and other programs leads to identify program needs, strengthen service delivery, develop and maintain policies and procedures, and support current and future Behavioral Health contracts and initiatives.

In addition to clinical and program management responsibilities, this position serves as the designated lead for Community Integration Services (CIS) Medicaid billing activities related to behavioral and mental health services. The QMHP oversees CIS billing workflows, service documentation, claims follow-up, and reimbursement processes; supports compliance with applicable Med-QUEST and QUEST Integration health plan requirements; and works collaboratively with staff and organizational leadership to promote accurate, timely, and compliant reimbursement for eligible CIS services.

Job Responsibilities:

• Provide direct supervision and day-to-day leadership to assigned Behavioral Health staff.
• Manage personnel matters for assigned staff, including performance expectations, coaching, corrective guidance, scheduling and workload concerns, professional development, and other supervisory responsibilities in coordination with organizational leadership.
• Assign and monitor caseloads and service responsibilities for Behavioral Health Care Coordinators.
• Facilitate regular team meetings and promote effective communication, coordination, and accountability within the Behavioral Health team.
• Provide clinical supervision, consultation, and guidance to Behavioral Health staff.
• Coordinate Behavioral Health trainings across disciplines.
• Organize and participate in clinical case conferences and interdisciplinary team conferences.
• Review and approve initial Behavioral Health assessments and individualized treatment plans.
• Provide individual and team clinical consultation to RYSE programs and staff as needed.
• Review incident reports, conduct or participate in root cause analysis, and guide appropriate program or practice improvements.
• Support quality assurance activities, including internal audits, documentation review, compliance monitoring, and continuous quality improvement.
• Develop, implement, and maintain Behavioral Health policies, procedures, workflows, and operational practices.
• Assist with Behavioral Health program planning, implementation, evaluation, and continuous improvement.
• Support collection, review, and analysis of program data to monitor service delivery, outcomes, contractual requirements, and performance measures.
• Contribute program information, data, outcomes, and narrative content to funding reports, contract reports, grant applications, and grant reports in collaboration with organizational leadership and designated grant or development staff.
• Monitor program operations and assist leadership in identifying staffing, service delivery, resource, compliance, and program development needs.
• Participate in development and implementation of current and prospective Behavioral Health contracts and initiatives.
• Ensure adherence to applicable contractual requirements, clinical documentation standards, HIPAA requirements, and Behavioral Health billing and record-keeping expectations.
• Serve as the program lead for Community Integration Services (CIS) Medicaid billing and reimbursement activities related to RYSE behavioral and mental health services.
• Oversee CIS billing workflows to support accurate and timely submission of claims for eligible services, including verification of member eligibility and authorization requirements, service documentation, and applicable health plan billing requirements.
• Review program and service documentation for alignment with CIS requirements and collaborate with staff to resolve documentation or billing deficiencies before claim submission or resubmission.
• Coordinate with QUEST Integration health plans, Med-QUEST, organizational leadership, and other applicable partners regarding CIS authorizations, billing requirements, claim issues, denials, and reimbursement concerns.
• Monitor CIS claims and reimbursement activity, identify billing or documentation trends, and support timely correction, resubmission, and follow-up on denied or outstanding claims.
• Maintain current knowledge of CIS Medicaid requirements, provider guidance, allowable services, documentation standards, and billing changes, and communicate relevant updates to Behavioral Health staff and organizational leadership.
• Support collection and reconciliation of CIS service and billing data for internal quality assurance, contract monitoring, funding reports, and required program reporting.
• Develop and maintain internal workflows, procedures, and staff guidance necessary to support compliant CIS service documentation and billing practices.
• Provide program oversight for ADAD substance use prevention program, including coordination of implementation, staff support, and adherence to program and funding requirements.
• Monitor program data, outcomes, and implementation fidelity and support required evaluation, and reporting.
• Provide crisis stabilization and clinical intervention as needed.
• Maintain a limited clinical caseload as needed, particularly for youth requiring a higher level of clinical expertise.

Required Qualifications:

• Holds a current clinical license in good standing as a QMHP in the State of Hawaii.
• Able to independently contract and bill Medicaid and Medicare insurance as a Behavioral Health provider.
• 3-5 years of clinical field experience in direct service treating an array of behavioral health diagnoses including but not limited to mood disorders, PTSD, serious and persistent mental illness, substance use disorders, and anxiety disorders.
• Demonstrated ability to supervise staff, provide team leadership, and manage personnel and program responsibilities.
• Working knowledge of the behavioral health landscape of community providers and systems within the State of Hawaii.
• Direct work with young adults and houseless individuals in the State of Hawaii is preferred; CSAC preferred.

Educational Requirements:

• Master's Degree in social work, counseling, or related field.
• Current clinical licensure as a QMHP in the State of Hawaii.

Physical Demands & Work Environment

This position involves engaging with diverse communities, participating in site visits, and attending policy discussions. Reasonable accommodations will be made to ensure accessibility.

While primarily office-based, occasional fieldwork, community meetings, and housing site evaluations may be required. Standard office responsibilities include document preparation, computer use, and phone communication.

Commitment to Diversity & Inclusion

RYSE is committed to equity, inclusion, and social impact. We encourage applications from individuals of all backgrounds, including members of the LGBTQ+ community and those with lived experiences in housing insecurity.