Care Coordinator (Accordia Family Medicine)

Responsibilities

Primary Job Functions: General Responsibilities: Liaison between Accordia-COP, CMHC and/or PCP as appropriate Provides ongoing monitoring and care coordination for consumers on caseload Provides care management services to consumers transitioning from more to less restrictive levels of care for medical and psychiatric issues Assists with meeting reporting requirements of the SAMHSA grant and UDS data Provides support and advocates on behalf of the consumers in order to secure community resources and needed services Effectively collaborates and consults with staff members, including clinicians and pharmacists, and outside sources in the delivery and arrangement of care management services Evaluates and assists in consumer transfer/discharge planning Provides training on disease management and healthy living skills according to the consumer’s target goals as identified by care plan Demonstrates the ability to recognize the elements of a crisis state and knows how to deescalate or resolve the situation Provides psychoeducational services to patients and families Demonstrates the ability to assess and reevaluate the consumer needs utilizing the CANS, PHQ2, PHQ9, CRAFFT, GPRA and/or other approved assessments as appropriate Identifies and reassesses goals and plans for appropriate services utilizing the consumer’s care plan Provides appropriate linkage to community resources Delivers or arranges clinically necessary transportation Effectively demonstrates the application of child and adult specific competencies Medical Monitoring as defined below: Basic knowledge of normal vital signs including temperature, pulse, blood pressure, and respirations Recognizing and reporting vital signs outside of normal ranges Recognizing factors that influence temperature, pulse, respirations, and blood pressure Recognizing normal BMI for consumer’s height and weight Recognizing changes in nutritional status such recent weight loss or weight gain Identifying factors that contribute to obesity and chronic health care conditions such as poor diet, inactivity and sedentary lifestyle Educate consumer on ways to adhere to prescribed diet Recognizing and reporting changes in the consumers medical and mental status Basic knowledge of operation of assistive devices such as wheel chairs, canes, and walkers Recognizing signs and symptoms of emergency medical conditions and when to call 911 Provide education in the maintenance of medications to include recognizing medications and understanding the purpose of medications, possible side effects and what to do when a dose is missed, extra dose taken, or side effects/adverse reaction occur Provide documentation of services rendered in the appropriate space indicated to include but not limited to consumer problem(s), interventions provided, and consumer response to interventions, referrals, collaboration with other care managers, follow up appointments, case management and community outreach services, etc. Documentation of assistance with emergency medications and proper reporting Recognizing signs and symptoms of abuse and neglect and proper reporting Supervision and Consultation: Seeks supervision and consultation as needed Accepts and employs suggestions for improvement Actively works to enhance skills Clinical Record Keeping: Documents in a timely fashion per AltaPointe policy Documents in a clear and concise manner. Documents legibly Courteous and respectful attitudes towards consumers, visitors and co-workers: Treats consumers with care, dignity and compassion Respects consumers’ privacy and confidentiality Is pleasant and cooperative with others Assists consumers and visitors as needed Personal values don’t inhibit ability to relate to and care for others Is sensitive to consumers’ needs, expectations and individual differences Is gentle and calm with consumers and families Adopts a team work approach with coworkers Administrative and Other Related Duties as Assigned: Actively participates in Performance Improvement activities Actively participates in AltaPointe committees as required Completes assigned tasks in a timely manner Follows AltaPointe policies and procedures Attends appropriate in-services training and other workshops

Qualifications

Bachelor’s degree in a behavioral health or social services related discipline. Certification of case management training by Alabama State Department of Mental Health and experience within the Care Management field preferred; valid verifiable state-issued driver’s license; knowledge in child and adolescent specialties, outlined below, to be attained within six (6) months of employment: Knowledge of psychiatric disorders in child and adolescent populations Knowledge of chronic medical conditions Basic knowledge of growth and development of child consumers as related to all intellectual, emotional, spiritual, and physical aspects consumer development Basic knowledge of behavior management and parenting issues Knowledge of cultural diversity Knowledge of Trauma Informed Care principles Knowledge of behavior management, crisis intervention and interventions common to acute psychotic consumers, as well as, to non-violent crisis intervention practices. Knowledge of educational methods appropriate to the children and adolescents Knowledge of behavioral health screening tools (PHQ2, PHQ9, CRAFFT, GPRA and certified by the DMH to administer the Child and Adolescent Needs and Strengths (CANS) Knowledge of social determinants of health Knowledge of available referral sources for physical health, mental health and social services Basic knowledge of utilizing Electronic Health Records Basic knowledge of DMH and Medicaid standards