Community Health Center Hiring For Behavioral Health Care Coordinator at Middletown, CT, United States Full Time

Job Description

Summary:
community Health Center, Inc. (CHC), with offices in Connecticut, Colorado and California, is one of the country’s most creative and dynamic providers of primary medical, dental, and behavioral health services, and a leader in practice-based research, health professionals training, and use of innovative technologies to advance health and healthcare. CHC is designated as a federally qualified health center and a patient-centered medical home by HRSA, the Joint Commission, and NCQA, respectively. We deliver more than 600,000 patient visits per year from primary care hubs and community clinics across the state of CT, all connected by technology and common standards for quality. We employ several hundred medical, dental, and behavioral health providers who are engaged in practice, teaching, and research. Our Weitzman Institute is devoted to research and practice transformation and is recognized around the country as one of the premier research institutes focused on improving health care and health outcomes for special and vulnerable populations. In addition, the organization has developed three wholly owned subsidiaries from the original pilot developments within the Weitzman Institute: the National Nurse Practitioner Residency and Fellowship Training Consortium (NNPRFTC), the National Institute for Medical Assistant Advancement (NIMAA), and ConferMed.
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II. GENERAL RESPONSIBILITIES
Care Coordination is essential to the Patient Centered Medical Home Plus model. Coordinating with primary care teams members to discuss PCMH+ patients at a designated Integrated Care Team meetings (ICM). The BH coordinator is responsible to establish and facilitate ICM’s to focus on panel management, chronic disease management, case management, Identifying gaps in care, and transitions of care that the identified PCMH+ patients have experienced. Community Health Center has determined that a Behavioral health trained employee is best suited to fill this role.
The BH Care Coordinator is responsible for helping the care team to optimize the health outcomes of a defined sub-set of patients identified by systematic processes as having complex needs and for whom such care coordination is likely to lead to improved clinical outcomes including, but not limited to, better control of chronic illnesses and reduced transfers to higher levels of care such as hospitalization and emergency room visits. This defined panel of patients will be drawn from the identified PCMH+ patient panels of the primary care providers of the pod(s).
. The BH Care Coordinator works collaboratively with other members of the health care team including the primary care providers, medical assistants, behavioral health providers, nurses, medical assistants, Pharmacists, Access to Care staff and other ancillary staff as well as outside agencies. The main responsibilities of this position include coordinating patient care and facilitating discussion among the integrated care team to enhance planning of clinical and social services, as well as collaborating with external agencies
III. REQUIRED QUALIFICATIONS

• BS required in a behavioral health field
  
• Knowledge of and commitment to patient population/community resources
  
• Bi-lingual English /Spanish or English/Polish a plus
  

IV. PRIMARY CONTACTS
Internal Frequency
1. Supervisor Daily
2. Senior QI Manager weekly /monthly
3. Operation Managers daily
3. Primary Care Team members daily
4. Pharmacies as needed
5. Community Behavioral Health
Agencies as needed
V. PHYSICAL EFFORT/ENVIRONMENT
Physical labor is minimal for this position.
VI. WORK SCHEDULE DEMANDS
This position is full time unless otherwise noted in postings.
VII. COMMUNICATION SKILLS
Excellent verbal and written skills are required. This position is highly involved with staff, providers, colleagues and community resources.
VIII. CONFIDENTIALITY OF INFORMATION
Professional standard of confidentiality of patient records and conversations
IX. SIGNIFICANT JOB FUNCTIONS

• Works with the primary care team to identify PCMH+ patients requiring integrated care coordination services, including those transitioning from acute care, those with uncontrolled chronic illnesses, and those with other complex medical/psychological needs
• Maintains a tracking system to easily keep track of patients currently receiving ICM coordination services
• Attends ICM’s with each Primary Care Team
• Utilizes innovative modes of communication to engage team members in critical thinking during the ICM’s
• Conducts nursing visits daily with identified patients for chronic disease support,
• Assists staff to identify any “navigation” issues to ensure that patients they are able to attend scheduled medical visits both at CHC and outside the agency
• Coordinates with the Operation Managers to ensure scheduling blocks fo the ICM’s hosting at least one meeting per month at each site
• Prepares each patient case for presentation to the ICM team
• Track staff participation in ICM’s
• Documents ICM discussion in the eCW ICM template
• Document in the Circle of Care
• Identifies BH clients who are in need of a WRAP or Psychiatric Advance Directives

X. Training requirements

• ICM training

Location:
Community Health Center of Middletown
City:
Middletown
State:
Connecticut
Time Type:
Full time