REPORTS TO: Director of Behavioral Health and Deputy Medical Director (Attleboro and Taunton)
FSLA STATUS: Non-exempt
LOCATION: Sturdy Memorial ED/Manet at Attleboro

General Definition and Scope of Job

The ED Diversion Behavioral Health Case Manager is responsible for clinical case collaboration and performing assessment, care management for ED and admitted patients and members as indicated with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care
plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs within primary care with integrated mental health and substance use services.

Core Responsibilities

  1. Interviews patients with the ED and high utilizers of ED services for complete social and relative histories. Designs a plan of care based on assessment of mental and social needs and in collaboration with the primary care providers, patient and family;
  2. Ability to interpret the plan of care to the patient and the family; and facilitates follow-up patient care when indicated;
  3. Represents the health center when within the setting of the community hospital ED and within all area of the hospital and units while maintaining high-contact with supervision at the health center and determined point leads on site.
  4. Keeps informed of and utilize supportive services and referral channels for the accomplishment of quality care;
  5. Collaboratively works with other caretakers toward patient education and rehabilitation including promotion of optimal health.
  6. Assumes responsibility as embedded staffer of maintaining the confidence and collaboration of ED and staff of community hospital partner.
  7. Appropriately documents, collaborate with the health center care team including members of primary care, including nursing and quality, and communicates patient’s needs through symptoms, objective signs, assessments and plans.
  8. Serves as patient advocate.

Care management responsibilities

  1. Team Leader: Assists providers with care coordination and guide other members of the healthcare team to improve outcomes. Meets with team members and providers to review care plans and next steps.
  2. Care Coordination: Supervise outreach to patients who frequent ED users. Assist selected patients with achieving health maintenance goals, chronic disease care, and navigation to social service agencies for psycho-social issues and connection to primary care. Engages in relationship building with patients.
  3. Patient Self-Management: Educates patients about their conditions and the role RN case management, nutrition, primary care, and addiction and mental health services can play in stabilization and wellness. Gives support for therapeutic compliance and proper use of the emergency department. Connects patients to health center, specialist, and community and behavioral health and recovery resources as indicated to support goal setting and care plan
  4. Technology: Uses EMR and registries to create reports to direct improvement activities of teams and communicate progress to health center staff. Competence in EXCEL.
  5. Performs other appropriate job duties as assigned

Minimum Skills, Experience and Educational Requirements

  • Has knowledge of mental health and addiction principles including disease processes, presentations, resource generation and the continuum of care.
  • Possesses and displays the ability for good judgment with the confidence to act independently, yet collaboratively; observed standards of quality and safe patient care and assessment and the resolution of problems both clinical and non-clinical;
  • Maintains professional composure and confidence during stressful situations; and
  • Communicates clearly and with good faith and anticipates circumstances and is part of the problem solving process.

Required Certifications and Licenses

  • Preferred degree in human services, health promotion, counseling, social work.
  • Previous experience in health care, ambulatory care or public health required; emergency department,
    mental health crisis center, or addiction services preferred.
  • CPR

Critical Demands of the Job

  • Manage multiple requests and prioritize appropriately.
  • Work within an emergency department and hospital setting as well as health center practice locations.
  • Ability to function in a faced paced setting with a variety of patients and staff.
  • Attention to details and prompt follow up.
  • Includes walking and standing for long periods of time, sitting for short periods of time, hand dexterity, clear hearing and speaking ability. Must be able to lift a maximum of 1/3 of their body weight.
  • Excellent organizational, technological (telehealth, email, health record), and interpersonal skills.

Working Conditions

  • Works in well-lighted environment with comfortable surroundings.
  • Stressful at times due to competing demands, including attention to multiple patients and staff.
  • Will comply with all applicable laws, and will cooperate with the Manet Community Health Center and Community Hospital partner’s compliance program rules and regulations.

Required Availability

Position will require afternoons and evenings, and could include a rotating schedule, different sites, holidays and weekends