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PBH Local Business Plan 2007 <br />Service Management <br />MISSIOn: Our mission is to ensure that people accessing the PBH System of Care are linked to care that is <br />clinically appropriate and meets both the urgency and nature of their conditions. <br />Service Management <br />Current Operations <br />Office of Medical Affairs: Piedmont's Medical Director is the Chief Medical Officer for the Piedmont LME. The <br />Office consists of both a Medical Director and Assistant Medical Director. Both are board certified psychiatrists. The <br />Office of Medical Affairs is responsible for the overall clinical management of services to consumers, including <br />authorization of services, and utilization management. Other activities include collaboration with PBH network <br />providers, medical providers in the community, and State and community hospitals. <br />Utilization and Clinical Management: The Clinical Management Department manages the LME Access system, <br />including a call center, authorization and care management system, utilization management functions, and crisis <br />response network. The unit defines review gates, completes wncurrent and retrospective reviews, and responds to <br />appeals. Additionally, the unit researches utilization trends, identifies areas for further study and reviews, and <br />develops Clinical Pathways and written protocols. Care Managers provide clinical review, support and follow up to <br />ensure consumers receive the care that they need. This unit supports the Clinical Advisory Committee. The Office of <br />Medical Affairs is involved in all aspects of the operation of this unit, <br />Access: The Access Department is responsible for the operation of a 24 hour call center. The call center is <br />responsible for both telephonic and face to face screening, triage and referral of consumers requesting services. The <br />call center includes Qualified and 4icensed Professionals that respond to telephone calls. The nature of calls is <br />informational, or for screening/enrollment, and in response to crisis and emergencies. The Access department also <br />has an Outreach Team of qualified and Licensed Professionals (STR: Screening Triage Referral) that work in the <br />community to assist consumers in accessing the system, and responding when telephonic care management is not <br />enough. This team also includes specialists that coordinate developmental disability, substance abuse and psychiatric <br />hospital facility discharges. <br />lS - -1 36 <br />