Care Facilitator - Behavioral Health, Atrius Health

UnitedHealth Group•Quincy, MA

1d•$20 - $36

About The Position

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. This role supports coordinated, patient‑centered care for at‑risk individuals by facilitating care plans, monitoring adherence, and serving as a key liaison between primary care, behavioral health teams, and patients or their families. Responsibilities include assessing social, cultural, and health literacy factors affecting care; tracking appointments, referrals, tests, and medication compliance; and conducting outreach through phone. The position manages and analyzes data, prepares summary reports and presentations for clinicians, and ensures accurate documentation in the electronic medical record.

Requirements

High School diploma or equivalency certificate (e.g. GED, HiSET, TASC Test) from an accredited institution or governmental unit
3+ years of experience in a clinical or social services setting
Computer skills that include proficiency with electronic medical records (EMR), Microsoft Office – especially Word and Excel
Knowledge and understanding of medical terminology
Solid interpersonal and communication skills needed with the ability to interact effectively with patients and medical professionals

Nice To Haves

Experience in a Behavioral Health–related setting
Ability to demonstrate a high level of cultural competence and sensitivity to patient needs and concerns
Ability to engage patients in problem solving
Sound judgment with the ability to work and make decisions in a fast-paced environment
Excellent telephone skills, strong customer service and ability to build relationships with patients
Ability to use all electronic tools and applications relevant to the performance of the duties of the position, including but not limited to phone, keyboard, computer and computer applications
Performs all job functions in compliance with applicable federal, state, local and company policies and procedures
Accesses only the minimum necessary protected health information (PHI) for the performance of job duties
Complies with all Atrius Health and departmental privacy policies, procedures and protocols

Responsibilities

Facilitates the process of care for at risk patients, coordinates an accessible plan of care and tracks adherence
Serves as a liaison between the primary care team, behavioral health clinicians and patient and/or patient’s family
Develops an understanding of patient’s circumstances, health literacy, language and cultural beliefs or other social challenges impacting patient care or compliance and documents in medical record, as appropriate. Shares information learned with health care team
Tracks patient adherence with scheduled appointments, labs, studies, referrals, and prescription compliance
Serves as a resource in the collection and management of data, generation of reports, patient outreach and tracking of patient progress. Extracts and analyzes data; creates presentations to inform clinicians of analysis and summary reports
Contacts patients via telephone calls, MyHealth and/or direct mailings. Guides patients through process of care including transitions, providing directions, identifying barriers and approaches, serving as advocate and facilitator. Supports communication with clinicians and validates patient understanding. Confers with primary care case manager or other resources to facilitate assistance for patient
Ensures all necessary documentation is entered into patient’s electronic medical record
Assures that all medical records and documents are obtained from providers and schools in a timely fashion to have readily available for patient visits and roster reviews
In collaboration with clinical team, identifies relevant patient education materials and community resources and distributes to patients
Maintains a list of current community resources for frequently encountered issues. Confers with primary care social workers as needed
Documents processes and standard work. Works with clinicians and management to identify opportunities to improve quality performance and implement recommended changes. Actively participates in care improvement activities
Ability to assist with cross coverage
Performs other duties as assigned
Expected to be on site a minimum of once a week, that could be at any of the sites supported by the Quincy BH Hub