SUMMARY OF RESPONSIBILITY:
The Behavioral Health Specialist (BHS) is integral to population health management, including the integration of primary and behavioral health care through support of the primary care physician (PCP) and the care team. The BHS identifies, triages and manages patients with behavioral health problems and substance use disorders. In addition, the behavioral health specialist provides skill training through psychoeducation and patient education strategies and develops specific behavioral change plans for patients and behavioral health protocols for target populations.
ESSENTIAL FUNCTIONS:
HAS A WORKING UNDERSTANDING OF PATIENT CARE DELIVERED IN THE AMBULATORY SETTING AND ALSO VALUES THE VISION AND STRATEGIES OF POPULATION HEALTH TO BECOME MORE ACCOUNTABLE FOR BETTER CARE, BETTER EXPERIENCES AND REDUCED HEALTHCARE COSTS FOR THE POPULATIONS BEING SERVED.
IDENTIFY AND ENGAGE APPROPRIATE PATIENTS FOR BEHAVIORAL HEALTH CARE MANAGEMENT FROM LISTS AND REFERRALS, IN COLLABORATION WITH SUPERVISORS AND LOCAL CLINICAL SITE LEADERS.
AS A MEMBER OF THE CARE TEAM WORKS WITH COMMUNITY HEALTH WORKERS, RECOVERY SPECIALISTS, CARE MANAGERS AND PATIENT/CAREGIVER TO DEVELOP AN INTEGRATED PLAN OF CARE.
BUILDS CARING RELATIONSHIPS WITH TARGET POPULATION TO PROMOTE POSITIVE HEALTH AND SOCIAL SERVICE OUTCOMES.
COORDINATES AND/OR COMPLETES ALL BEHAVIORAL HEALTH ASSESSMENTS AND GOALS THAT ARE PATIENT CENTRIC AND SOLUTION-ORIENTED IN ORDER TO BUILD TREATMENT PLANS FROM PROGRAM ADMISSION TO DISCHARGE, WITH PATIENT, FAMILY AND SERVICE PROVIDERS. COORDINATES IMPLEMENTATION OF THE TREATMENT PLAN WITH ALL PROVIDERS.
PARTICIPATES IN CASE CONFERENCES, STAFFING MEETINGS, TREATMENT TEAMS AND OTHER CONSULTATION MEETINGS, AS DIRECTED BY SUPERVISOR AND AS NEEDED TO ENSURE A SUCCESSFUL TREATMENT PLAN
WORKS WITH THE PRIMARY CARE PROVIDER TO REFER CASES TO BEHAVIORAL HEALTH SPECIALISTS AS APPROPRIATE AND ASSISTS IN THE IDENTIFICATION OF AT-RISK PATIENTS AND DEVELOPMENT OF PLANS TO PREVENT FURTHER PSYCHOLOGICAL OR PHYSICAL DETERIORATION.
PRO-ACTIVE MANAGEMENT AND FOLLOW-UP (HOME VISITS AND BY TELEPHONE) ACCORDING TO CARE PLAN THAT INCLUDES INCORPORATION OF SELF-CARE AND SHARED DECISION MAKING IN ALL ASPECTS OF PATIENT CARE.
COACHING PATIENTS IN THE DEVELOPMENT OF SELF-MANAGEMENT GOAL SETTING AND BEHAVIOR CHANGE SKILLS FOR ATTAINING THEIR GOALS.
IDENTIFICATION OF SDOH NEEDS AND FACILITATION OF PATIENT AND CAREGIVER ACCESS TO COMMUNITY RESOURCES RELEVANT TO PATIENT’S NEEDS, INCLUDING REFERRALS TO TRANSPORTATION PROGRAMS, MEALS ON WHEELS, SENIOR CENTERS, CHORE SERVICES, ETC.
ATTENDS REQUIRED MEETINGS AND PARTICIPATES IN COMMITTEES AS REQUESTED AND ASSISTS WITH SPECIAL PROJECTS AS NEEDED.
CULTIVATES POSITIVE RELATIONSHIPS WITH ALL PATIENTS, CUSTOMERS, GUESTS, AND MEMBERS OF THE CARE TEAM.
EDUCATES PATIENT, FAMILY AND OTHER HEALTH CARE MEMBERS ON THE ROLE AND PURPOSE OF CARE COORDINATION, ITS PROCESSES, DISEASE/CASE MANAGEMENT PROGRAMS AND OUTCOMES AND MAKES REFERRAL TO APPROPRIATE CARE COORDINATION SERVICES AS NEEDED.
MAINTAINS A WORKING KNOWLEDGE OF APPLICABLE FEDERAL, STATE, AND LOCAL LAWS AND REGULATIONS, TRINITY HEALTH’S ORGANIZATIONAL INTEGRITY PROGRAM, STANDARDS OF CONDUCT, AS WELL AS OTHER POLICIES AND PROCEDURES IN ORDER TO ENSURE ADHERENCE IN A MANNER THAT REFLECTS HONEST, ETHICAL, AND PROFESSIONAL BEHAVIOR.
OTHER FUNCTIONS:
Performs other duties as assigned.
THE DUTIES LISTED ABOVE ARE INTENDED ONLY AS ILLUSTRATIVE OF THE VARIOUS TYPES OF WORK THAT MAY BE PERFORMED. THE OMISSION OF SPECIFIC STATEMENTS OF DUTIES DOES NOT EXCLUDE THEM FROM THE POSITION IF THE WORK IS SIMILAR OR A LOGICAL ASSIGNMENT TO THE POSITION.
QUALIFICATIONS AND COMPETENCIES:
Master’s Degree in Human Services or related field required
LCSW required; Current and valid Driver’s License. May be required to obtain license in secondary state.
Three or more years of diversified, progressive experience in an acute care and/or other settings appropriate to social work.
Excellent organizational skills required, with the ability to communicate and work collaboratively with all levels of staff, payors, providers and office staff, and effectively utilizing all resources available.
Requires culturally Competent Interpersonal & Communication Skills. Ability to read and comprehend complex instructions, short correspondence, and memos. Ability to write complex correspondence. Service requires proofreading and checking documents for accuracy. Ability to effectively interview patients/caregiver and accurately record medical information. Ability to effectively present information in one-on-one and small group situations to patients/caregiver, and other employees of the organization. Ability to effectively relate pertinent information with medical and social service professionals.
Must be adaptable to unpredictable situations in a patient care setting while effectively managing assigned duties with precise attention-to-detail, accuracy and follow through, with minimal supervision.
Maintains strict confidentiality with patient information in a professional manner.
Ability to use computer software and Microsoft Office applications, including Excel spreadsheets, is required.
Understanding of nationally recognized standards of care, managed care methodologies, and an awareness of dynamics occurring within the healthcare delivery system are key components of this position.
Ability to perform job with integrity and values consistent with the organization’s Mission, Core Values and Standards.
May be required to work embedded within provider practice as patient needs and volume dictate.
Ability to travel to hospitals, skilled nursing facilities, patients’ homes, and other sites where patients receive care (as indicated by patients’ needs).
Knowledge of defined area of nursing and allied health services. Familiarity with state-of-the-art developments in medical field.
Knowledge of federal and state laws relating to clinical care, professional ethics related to the delivery of clinical care.
Must possess excellent interpersonal skills, with a flexible and creative approach to problem solving. Ability to facilitate discussion and build consensus.
Ability to analyze complex data and draw conclusions needed to develop clinic policy and procedures.
PHYSICAL AND MENTAL REQUIREMENTS:
Concentrates, organizes efficiently and independently organizes work. Assumes cross coverage responsibilities. Physical effort involved in walking to conduct interdepartmental business. Position requires ability to occasionally lift light objects; frequently performs moderately difficult manipulative, gross body coordination and hand-eye coordination tasks; walks, stands and sits for prolonged periods; sees objects closely and hears normal sounds with some background noise. Ability to frequently concentrate on fine detail with interruption and attends to tasks for more than 60 minutes at a time. Individual must be able to understand and relate to theories behind several related concepts, remember multiple tasks given over long periods of time and be able to communicate in written word using advanced written skills. Driver's license and ability to travel at least 30%.