The Behavioral Health Care Manager provides care management for specified CCBHC patients, Health Center patients, and community members in need of care management at Sun River Health. These patients may be referred by providers/clinical team; enrolled as a Behavioral Health CCBHC Program, or be included in care management as part of a grant, insurance program, or disease-specific program. Links patients to preventive and primary health care services including care for: acute, chronic and communicable diseases; dental services; prenatal care and family planning; WIC and other nutrition services; pediatric care and immunizations; and behavioral health or substance abuse programs as needed. This includes assistance with community resources, social services, and referrals. This position will be responsible for proper and timely documentation within eCW and any designated care management software, as well as communication with internal and external referral sources to capture services provided. Performs other duties as assigned on an as-needed basis.
Responsibilities Responsible for completing outreach and subsequent intake activities using required forms and documents as required. This may include program-specific additional consents and assessment tools. Document as directed in eCW and designated program software.
Responsible for referring patients to needed services as directed by provider to support care plan/treatment goals, including medical/behavioral health.
Responsible for release of all necessary clinical information to specialist referral; tracks referral appointments and obtains consultant reports with appropriate consent for release of information and documents process in eCW per Sun River Health procedure and designated software for care management.
Consult with health care team to link patient to community/social services programs and entitlements: including application assistance; transportation assistance; translation services; housing services; self-help recovery and self-management programs as needed.
Conduct client outreach and engagement activities at least monthly to evaluate for ongoing emerging needs and to promote continuity of care and improved health outcomes.
Follow up with Hospitals/ER upon notification of admission or discharge and coordinate with health care team to facilitate communication of the event and transition of care services, to include, but not limited to medication reconciliation with the health care team as per policy.
Assist patient in developing plans and community supports to overcome obstacles that would prevent them from receiving needed services/referrals.
Provide basic instruction/health education to clarify provider instructions, procedures and referral needs.
Conduct field visits to coordinate the care of patients.
Education:
High School Required
Bachelor's Degree Optional
Pay: $23.00-$25.00
Full Time
Relation to Mission The mission of Sun River Health is to increase access to comprehensive primary and preventive health care and to improve the health status of our community, especially for the underserved and vulnerable.
Equal Employment Opportunity Sun River Health provides equal employment opportunities to all qualified individuals without regard to race, creed, color, religion, national origin, age, sex, marital status, sexual preference