Job description

The purpose of this position is to work within an integrated system of care between primary care and mental health, ensuring that patients seeking medical services are screened for mental health conditions such as anxiety, depression and substance use, and provide assistance in navigating the systems of care (internal and with community partners). Utilizing Valley Community Healthcare’s (VCH) Patient Centered Medical Home protocols, the BHCM will engage with patients over the phone and in-person while working with clinic care teams to enhance patient centered care. The BHCM works as an integrated member of the interdisciplinary clinic team to communicate patient’s needs and care plans to the team members. The BHCM also helps patients navigate across the continuum of health care, including services received outside of VCH.

CORE JOB RESPONSIBILITIES (Essential Duties):

Operations/Compliance

· Case Manager Specific Duties

o Ensure that new patients and as appropriate, returning patients complete required screening tools;

o Perform brief consultation with patients with high scores during their medical visit;

o Work closely with medical providers and care team to intervene with patients needing immediate consults;

o Perform triage services, crisis intervention, case management, referrals and follow-up as required;

o Develop a collaborative relationship with primary care providers;

o Participate in care team huddles and weekly clinical team meetings.

o Participate in clinical supervision meetings;

o Complete all required documentation by the end of each day

o Score tools and enter results into EHR.

o Offer and provider prevention services

o Manage the department’s referrals by systematically enrolling and scheduling patients for mental health services, as designated by the payer source

o Provide community resources to patients

· Enhanced Care Management specific duties:

o Connects VCH patients to other social services and supports

o Advocates on behalf of members with health care professionals

o Uses motivational interviewing and trauma‐informed care practices

o Works with hospital staff on discharge plan

o Engages eligible patients in clinic services

o Accompanies patients to office visits, as needed

o Monitors treatment adherence (including medication)

o Provides health promotion and self‐management training

o Arranges transportation for patients

o Calls patients to facilitate visits with the care coordinators

o Ensure appropriate ER/Hospital follow up

o Coordinates pre-operative evaluations

o Promotes prevention and self-care strategies.

o Selects and recommends appropriate educational materials.

o Provides linkage to outside health education, wellness programs, and community resources

o Assists with translation for staff when necessary

o Outreaches to patients who have missed preventative services (well child exams, colon and cervical cancer screenings etc.)

o Coordinates appointments with health care providers to ensure timely delivery of diagnostic, treatment and wellness exams

o Assists with patient appointment reminders, missed appointment follow up and patient rescheduling

o Provides and promotes culturally appropriate interventions.

o Provides EMR Portal Assistance

o Performs appropriate documentation to maintain the standards set by VCH, with special attention to the ECM assessment and care plan.

o Collects and prepares reports and documentation as needed for planning and quality assurance.

o Participates in health center and department quality improvement initiatives.

o Maintains confidentially and complies with HIPAA and compliance mandates at all times.

o Attends and participates in meetings, committees, and training sessions as directed by Supervisor.

o Performs other duties as assigned by Supervisor.

o Collaborates with providers and care team staff to identify and monitor appropriate patients for · care management.

o Participates in development of patients' goals and care plans 'as well as make revisions to these based on changes in patient status.

· Perform other duties, tasks and procedures as assigned

Competencies:

To perform the job successfully, an individual should demonstrate the following competencies:

· Prior experience in a fast paced and large volume patient care/customer service establishments.

· Ability to communicate clearly.

· Ability to work with little supervision.

· Takes initiative to problem solve before escalating to supervisor.

· Ability to establish and maintain effective working relationships with patients, employees, and the public.

· Bi-lingual English/Spanish preferred.

· Customer Service – manages difficult or emotional customer situations: Responds promptly to customer needs; meets commitments.

· Interpersonal Skills – focuses on solving conflict; maintains confidentiality; listens to others without interrupting; keeps emotions under control.

· Oral Communication – speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; participates in meetings.

· Written Communication – writes clearly and informatively.

· Teamwork – contributes to building a positive team spirit.

· Visionary Leadership – inspires respect and trust.

· Ethics – treats people with respect.

Minimum Qualifications:

· A Bachelor’s degree in Social Work or related field.

· One year social work experience in a medical or mental health setting (either through direct employment or via practicum).

· A minimum of one year working in a community clinic or other medical office environment.

· Current California Driver License or Identification Card is required.

· Exhibits a high level of professionalism.

· Ability to relate and communicate well to all cultural and ethnic groups in the community, including fluency in written and spoken English. Bilingual skills in written and spoken Spanish are preferred.

· Ability to complete and maintain records in accordance with procedures utilizing an electronic health record system.

· General computer skills in Microsoft Office programs (Word, Excel, etc.) and electronic medical record systems.

Job Type: Full-time

Pay: $25.25 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance

Medical specialties:

• Psychiatry

Schedule:

• 8 hour shift
• Monday to Friday
• Weekend availability

Ability to commute/relocate:

• North Hollywood, CA 91605: Reliably commute or planning to relocate before starting work (Required)

Education:

• Bachelor's (Preferred)

Language:

• Spanish (Preferred)

License/Certification:

• Driver's License (Preferred)

Work Location: In person

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