Behavioral Health Case Manager

PUEBLO COMMUNITY HEALTH CENTER INC•Pueblo, CO

5d•$22 - $26•Onsite

About The Position

The Behavioral Health Case Manager provides services to the patient population of Pueblo Community Health Center to minimize barriers, improve overall health outcomes and empower patients to become an active participant in their own care. Collaborates with PCHC providers, clinical support staff and community resources to facilitate positive patient outcomes. Utilizes population health management strategies including basic analysis of data including social determinants of health to identify populations in need of intervention. Provides supportive intervention with identified populations including motivational interviewing, safety checks, reminder calls, connecting patients to internal and community resources to improve patient health outcomes, quality of life, and patient experience.

Requirements

Bachelor’s degree in a human services-related field required.
Minimum of five (5) years of healthcare experience required.
Equivalent combinations of education and relevant experience may be considered.
Current valid driver’s license and proof of auto insurance in accordance with state law required.
Ability to work independently.
Excellent interpersonal skills.
Ability to understand verbal information, ability to exchange verbal information with others and ability to present information verbally.
Ability to read and understand written materials and ability to compose information/instruction in written form.
Ability to memorize.
Ability to prioritize and be organized.
Ability to reason mathematically and to have analytical and problem-solving skills.
Computer skills including database utilization required.

Nice To Haves

Experience in behavioral health, case management, care coordination, social services, or a related field preferred.
Conversational Spanish desirable.

Responsibilities

Ensure the functions and activities of this department and embrace the philosophy, mission, and values of the Communicate with Heart Model service Model supported by the Board of Directors of Pueblo Community Health Center, Inc.
Adhere to the guidelines and procedures of Pueblo Community Health Center, Inc.
Follow instructions from the immediate supervisor and adhere to the established organizational chain of command.
Facilitate patient access to Pueblo Community Health Center, staff and resources at Pueblo Community Health Center.
Assess social drivers of health using approved screening tools and coordinate appropriate interventions and resources to address identified needs.
Provide support to patients and their families with assisted living and nursing home placements when identified by primary care and behavioral health providers.
Utilize screening tools and skills to identify appropriate resources, timely access and appropriate resources. (SDOH, PHQ9,).
Identify patient concerns and link to appropriate resources such as depression, anxiety, trauma, housing, transportation, income support.
Case manages patients within the practice that have been identified through screening activity and/or referred by behavioral health and medical providers that can benefit from behavioral health and/or case management services. This includes patients of special population programs i.e. Provide support to patients in special populations programs i.e. homeless, migrant health, MAT, Prenatal/OB, Behavioral Health and Chronic Health Management as well as other State and Federal Programs.
Initiate patient contacts to schedule Behavioral Health intake appointments and provide brief screens of patient needs, and strengths, using various screening tools and skills.
Assist patients to complete paperwork for assistance programs (Food Benefits, SSI, Medicaid/Medicare, assisted living and nursing home care).
Maintain appropriate and timely documentation of patient contact, referrals made, and services provided in the medical record.
In collaboration with Medical and Behavioral Health providers, determine appropriate and timely referrals to PCHC and community services.
Coordinate care with patients, family and community stakeholders to facilitate continuity of care and positive outcomes.
Create initial action plans/care plans to facilitate linkage to appropriate community PCHC resources and link patients to appropriate resources, which may include; behavioral health treatment, care coordination, community social resources and substance abuse treatment options.
Develop and maintain collaborative relationships with PCHC co-workers, providers and with community stakeholders.
Must have the ability to maintain proper boundaries with their patients, internal and community relationships.
Serve as an advocate and informational resource for PCHC patients, staff and community stakeholders.
Research resources and link patients to appropriate resources.
Maintain patient confidentiality per HIPPA.
Perform other related duties as assigned