JOB SUMMARY

In accordance with the agency Mission, Vision, Values and Goals, this position is responsible for ensuring that a continuum of health and behavioral healthcare for clients with serious mental illness (SMI) or severe emotional disturbances (SED) is provided along with access to healthcare, increasing client/family involvement as partners in their own health, and improving general health status. Responsibilities also include community awareness, outreach, and networking regarding availability of integrated service: as well as linking clients with community health care providers, both during treatment and upon discharge.

PRIMARY FUNCTIONS:

Provides education and/or case management services to clients who have been diagnosed (or may be at high risk for developing) physical health conditions. Ensures that all services are documented appropriately and monitors the client progress towards health lifestyle goals.

Acts as liaison with CMHS consumers/staff and Swope Health Services. Assists clients in gaining access to integrated health and behavioral health care.

Maintains training and certification in Smoking Cessation and as a Wellness Coach Trainer and provides education/training to consumers and staff as requested.

Provides outreach services to the agency’s Disease Management population and assists in linking them with services within the appropriate department in the agency.

Monitors and reports outcomes and service/support activities provided to clients involved in health access, healthy lifestyles, and tobacco cessation. Ensures that all program data is appropriately collected, compiled and reported in accurate and timely fashion.

Carefully monitors client progress toward healthy lifestyle goals. Serves as important member of the treatment team that focuses on the whole person, ensuring that persons-centered care and approach is utilized.

Through coordination with caregivers and others, is responsible for the retention of clients utilizing healthy lifestyle services until resolution of the presenting/diagnosed physical health compliant.

Participates in and meets ethical/agency standards regarding all treatment and documentation practices, QA/QI procedures, utilization management, emergency procedures, and program/client outcomes.

Follows all agency policies and procedures including emergency and corporate compliance policies/procedures 100% of the time.

SECONDARY FUNCTIONS:

May conduct nutrition, exercise or other psycho-educational classes under the direction and oversight HCH nursing staff.

May serve on departmental, program, or agency committee(s) or task team(s).

All other duties as assigned.

QUALIFICATIONS

Education:

Licensed Practical Nurse or Bachelor’s degree in psychology or related field that qualifies as Community Support Specialist: knowledge or minor field of study in health, biology or related field is preferred.

Experience:

One year of case management experience working with SMI Adults and/or SED Youth/families preferred

Licenses, Certifications, and Registrations:

None Required.

Special Skills:

Organizational Skills

Communication and Interpersonal Skills

Computer Literacy with Microsoft Word and Excel competency

Goal Directed and Self Motivated

Flexibility regarding scheduling

Time Management Skills

REQUIREMENTS FOR POSITION

Required trainings as outlined by DMH regulations and agency policy

DEGREE OF SUPERVISION

This position is supervised by the Health Care Home Director