Primary Integrated Care (PIC) Care Coordinator

Job Details

Job Location

Waterbury, CT

Position Type

Full Time

Salary Range

$46,125.00 - $49,200.00

Job Shift

Day

Description

GENERAL STATEMENT OF RESPONSIBILITIES

The Primary Integrated Care Coordinator is a critical position of the Adult Division’s functioning and organization. The Primary Integrated Care Coordinator is responsible for coordinating medical, psychiatric, and behavioral health services for patients who are enrolled in the Primary Integrated Care Department and shared Wellmore Behavioral Health and Staywell Health Center. The Primary Integrated Care Department’s Care Coordinator helps ensure that a holistic, whole-person approach is taken towards providing an integrated health care services by facilitating access to assisting in access to and coordination of the full array of primary and acute physical health services, behavioral health care, and community-based services and supports.

ESSENTIAL DUTIES AND RESPONSIBILITIES Include The Following

SERVICE/ACCESS COORDINATION

Identify and engage Primary Integrated Care clients based on eligibility requirements. Eligibility for the Primary Integrated Care Program is any individual 18 years or older who has a serious mental illness with co-occurring physical health conditions or chronic diseases, and/or individuals with a substance use disorder.Assist new Primary Integrated Care Clients in completing paperwork and releases of information needed to transfer or obtain medical care through Staywell Health Center.Work cohesively with the Wellmore Adult Division’s Admissions Coordinator to develop, implement and monitor the Primary Integrated Care’s admissions process.Monitor program census and provide direction to peer support specialist and medical staff for completion of biannual physical and behavioral health reassessments.Be the system navigator and point of contact for shared Wellmore/Staywell patients and families, with patients and families having direct access for asking questions and raising concerns.Assist patients during their primary care, behavioral health, and/or psychiatric appointments in understanding the relevant details of the visit, as requested by either the patient or the treatment team.Coordinate with Primary Integrated Care Administration Team to schedule appointments for primary integrated care clients with external behavioral health specialists, as requested by the medical, clinical, and/or psychiatric treatment teams and explain purpose of appointments in clear and simple language to the client.Participate as a member of a multi-disciplinary team including both medical, behavioral health and psychiatric team members towards the development and implementation of integrated health care services.Coordinate with treatment team as needed to ensure that both current diseases, as well as preventative and health promotion needs are addressed as part of the holistic, whole-person, culturally sensitive integrated care approach.

TEACHING & EDUCATION

Teach and assist shared Primary Integrated Care patients to better manage their chronic diseases using realistic and SMART (specific, measurable, attainable, realistic and timely) goals.Provide as-needed teaching to Primary Integrated Care Clients during medical, behavioral health, and/or psychiatric appointments to assist in the understanding of how to alleviate barriers to treatment.Assist patients and their families in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).Use a step-by-step process when teaching skills.Use positive reinforcement and encouragement.Use a flexible approach with a diverse population.Attend both mandatory in-service trainings and related conferences and provide feedback to staff on the content of educational programs attended.

ADVOCACY

Negotiate on behalf of the patient, as needed, with the medical, behavioral health and/or psychiatric treatment teams, and patients themselves by creating reasonable goals, clarifying the issues to be negotiated, following through with the agreement reached, while remaining flexible and consider culturally-sensitive and holistic alternatives.May assume advocate role on the patient's behalf to ensure approval of the necessary supplies/services for the patient in a timely fashion.Participate in community based health promotion events at the discretion of the Manager of Integrated Health, Vice President of Adult Services, Wellmore Leadership team or designees.

RECORD-KEEPING

Maintains documentation of care coordination services in accordance with all Wellmore Documentation StandardsCompletes documented follow-up with Primary Integrated Health clients who do not present for appointments.Complete required interagency and other necessary paperwork.Monitor confidentiality in accordance with Wellmore policy and legal requirements.Follow required office procedures in a cooperative manner.Initiate and process incident reports as per Wellmore guidelines.Assist with management and input of grant dataAdhere to Infection Control protocols.Other duties may be assigned at any time by the Manager of Integrated Care, Director of Adult Outpatient and/or Vice President of Adult Services or their designee.

Interpersonal Skills

Treat consumers with respect.Accept the values and lifestyles of consumers.Use a flexible approach with a diverse population.Communicate effectively and professionally with both Wellmore, Inc. and Staywell staff, representatives of other agencies and the public.Work in cooperation with coworkers and supervisory staff.Deal with coworkers regarding problems in a constructive and professional manner.Accept and utilize direction and supervision.

Qualifications

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Must be detail oriented. Must demonstrate computer competency in Windows and Excel with ability to quickly learn and accurately maintain agency-specific electronic files. Must display willingness and ability to adapt to new situations and challenges. Must consistently maintain a pleasant, professional attitude. Must demonstrate an ability to exercise exceptional judgment and deliver meet high standards of customer service. Must exhibit initiative and accept accountability for tasks. Must demonstrate and ability and willingness to work a flexible schedule, including coverage during vacations, illness and evening hours as needed. Must be able to travel to and work in different locations as needed.

Bachelor's degree (B. A.) from four-year college or university in Human Services or related field is required. Experience working with individuals with substance use disorders, co-occurring disorders or severe mental illness is preferred. Interest in working in a primary care clinic with medical staff strongly encouraged.