Wellness Coordinator (Part Time)

BHG Careers•Middletown, RI

3d•Hybrid

About The Position

The Health Home Coordinator will lead and manage the Health Home (HH) Team to ensure high-quality support and comprehensive care for patients. This role involves identifying OTP (Opioid Treatment Program) patients, conducting outreach, assessing needs, and developing individualized care plans in collaboration with patients. Key duties include assigning team roles, establishing care protocols, monitoring treatment progress, and implementing quality improvement (QI) activities to enhance patient care. The Health Home Coordinator also supervises case managers, facilitates team meetings, and manages patient engagement strategies, covering all aspects of Health Home services such as care management, care coordination, health promotion, transitions of care, and community referrals.

Requirements

Master’s degree, RN, or equivalent in Social Services, Psychology, Social Work, or Criminology from an accredited institution.
Familiarity with behavioral health and related experience.
Strong integrity and excellent communication skills to engage with diverse backgrounds.
Structured approach to handling high caseloads.
Ability to work at other BHG Rhode Island locations as needed.

Nice To Haves

New Master level graduates encouraged to apply.

Responsibilities

Facilitate Medicaid enrollment and automatic enrollment in the Health Home program, offering opt-out options.
Monitor and bill Health Home service notes using SAMMS.
Develop and implement a flexible, patient-centered care plan addressing clinical and non-clinical needs; update care plans based on any health changes.
Collaborate with Health Home nurses and providers on discharge planning for OTP patients and new referrals.
Coordinate access to preventive, health promotion, mental health, and substance use services.
Support continuity of care through comprehensive care management, care coordination, and transitional care.
Connect patients to community resources, social support, long-term care, and recovery services.
Educate and assist new patients in understanding and enrolling in the Health Home Program.
Offer practical support, advocacy, and problem-solving assistance to patients.
Provide nutritional education related to specific medical issues and conduct wellness interventions.
Maintain agreements with local hospitals and healthcare providers to support transitional care and enhance patient outreach.
Oversee a continuous quality improvement program, collecting data to evaluate and improve care coordination, outcomes, and service quality.
Ensure compliance with all federal, state, and local regulations and accrediting agencies.
Support and contribute to an inclusive work environment, embracing diversity.