Behavioral Health Case Manager (Care View Health Center)

Position Summary: Under the direct supervision of the BH Case Manager Supervisor, the Behavioral Health Case Manager is responsible for providing direct services and coordinating care for behavioral health patients with particular focus on those with complex needs. Specifically, the Case Manager works to ensure patients have access to the care and referral services needed to achieve and maintain optimal functioning. The Case Manager is responsible for providing case management services to patients engaged in or referred to Behavioral Health Services. The Behavioral Health Case Manager will participate in all-staff meetings, treatment team meetings, conduct presentations, and participate in patient engagement and communication with external agencies. Essential Functions of the Job: Provides direct services to patients, including case management, referral support, warm handoffs, and psycho-educational groups. Conducts a comprehensive assessment of the patients’ health and psychosocial needs, including health literacy status and deficits to identify appropriate level of care and create a case management plan in collaboration with family and department staff. Begins developing the therapeutic alliance with patients by providing an orientation to the behavioral health department and the services available. Identifies and supports patients and families who are eligible for services and in need of case management services. Coordinates patient care with behavioral health provider, Primary Care Physician (PCP), and/or psychiatrist via consultation, collaboration, follow up, and recommendations. Collaborates with other SYHealth Departments (e.g. Referrals, Social Services, Health Education, etc.) to facilitate and monitor referral requests and processes to ensure timely receipt of services. Assists patients and families in accessing resources and overcoming barriers to care. Manages internal and external referrals to the behavioral health department, including follow-up phone calls, sending letters, and communicating with referring staff. Educates patients, families, caregivers, and members of the health care delivery team about treatment options, community resources, insurance benefits, psychosocial concerns, case management, etc. so that timely and informed decisions can be made. Represents San Ysidro Health and the Behavioral Health Department in the community to create and maintain partnerships with other programs and to improve referral outcomes and quality of care for patients. Maintains timely, complete, and accurate records with detailed assessment results, action plan, and progress notes. Clearly documents plans discussed with the patient, family, behavioral health clinicians, PCPs, etc. in the electronic health record system to ensure that communication is available to all team members. Assists in the preparation of monthly narrative and statistical reports covering progress toward meeting process objectives and/or as required by department and organizational leadership. Provides patient engagement and collaborates with community agencies to identify patients who are eligible for behavioral health services and facilitates referral process. Maintains productivity of patient visits in accordance with clinic/program guidelines. Complies with established departmental and health center policies and procedures, objectives, quality assurance program, safety, environmental and infection control standards. Performs other related activities as required, assigned and/or requested. Additional Duties and Responsibilities Attends meetings, trainings, and community events as required and participates on committees as directed. Assists in monitoring the quality assurance and evaluation process ensuring that contract compliance and outcome and process objectives for patients and their families are met. Completes and submits required data entry and reports in a timely manner. Enhances professional growth and development through participation i…