Job Description

 

POSITION SUMMARY: Under supervision of Program Management, performs duties in support of therapeutic services and provides comprehensive direct support services which are structured to meet the needs of an adult population composed of SMI, dual-diagnosed and/or referred persons. Provides direct treatment, rehabilitative and supportive services in a community setting to members; works as a team member of a clinical team to assess member needs and wants, participates in the development of individual service plans, acts as a member advocate and liaisons with families and community agencies; provides on-call crisis intervention services, as well as weekend and holiday coverage; coaches members and families on behavioral and physical health conditions, self-management techniques; promotes treatment adherence and personal wellness within a recovery framework and coordinates member care within the clinical team and with external parties including the member’s primary care physician and specialists; performs related duties as required.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The duties listed below are intended only as illustrations of the 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, related or

 

  • Provides time-unlimited, community-based services to assigned caseload size of 10:1, ensures intake rate is low to maintain a stable clinical environment for other members on the case load.
  • Actively participates as part of the member’s clinical team.
  • Actively recruits new members who could benefit from ACT.
  • Takes full responsibility for the treatment services for members; coordinates care with ACT team members and other providers to ensure member’s needs are met and the member continues to receive treatment in the community to the greatest extent possible
  • Works with informal support system with or without the member present to provide clinical skills training to increase informal supports (family, landlords, employer etc).
  • Maintains high intensity of services and high-frequency contact with members as needed.
  • Utilizes assertive engagement mechanisms, including street outreach and legal mechanisms (probation/parole, court ordered treatment), when necessary, to re-engage the member in prescribed treatment.
  • Routinely assesses member’s need for ACT services, using explicit criteria to determine need to transfer to less intensive services. Gradually and individually transitions eligible members and ensure continuity of care. Monitors member’s status during transition and reintroduces services as needed to ensure member’s stability in the community.
  • Is responsible for crisis services for assigned members, coordinating hospital admissions and discharge planning.
  • Participates in daily team meeting; provides updates on assigned case load; identifies member’s risks and needs and coordinates care to access needed services. Serves as the subject matter expert in designated role; offering skills training and technical assistance
  • Complies with all program requirements per SAMHSA evidence based practice guidelines, Western Interstate Commission for Higher Education (WICHE), Mercy Maricopa and others as identified by Lifewell Behavioral Wellness.
  • Responsible for transporting members to necessary services, as outlined in their service plan, as needed.
  • Provides all services to members in accordance with established policies and procedures and clinical protocols to provide supportive counseling skill development and other support services as needed.
  • Works with member’s Prescribing Clinician and other members of the clinical team to ensure the timely development and implementation of the individual’s service plan (including all necessary assessments) and their crisis plan.
  • Assists members and families in accessing additional needed services and obtaining entitlements, including identification of funding services.
  • Assumes “primary contact” responsibility for a percentage of team members to: assure maintenance of accurate, thorough, and current documentation in the medical record (in accordance with policies, procedures, and clinical protocols) for those specific individuals; keep weekly member schedule for those individuals updates, and act as first contact for those members and their families.
  • Documents all member events in accordance with policies, procedures, and clinical protocols.
  • Manages the medication system, administers and documents medication treatment.
  • Screens and monitors members for medical problems/side effects.
  • Communicates and coordinates services with the clinical team and other medical providers and coordinates with the PCP, Integrated Care Provider or RBHA Care Management Department when developing member’s integrated, individualized service plan, as appropriate.
  • Engages in health promotion, prevention and education activities (i.e., assess for risky behaviors and attempts behavior change)
  • Educates other team members to help them monitor psychiatric symptoms and medication side effects.
  • When members are in agreement, develops strategies to maximize the taking of medications as prescribed (e.g., behavioral tailoring, development of individual cues and reminders).
  • Facilitates wellness groups and provides individual and group coaching re: chronic condition self-management.
  • Develops individualized service plans (ISP) that include goals related to member’s medical and behavioral health needs; screens for physical health issues.
  • Ensures clinical interventions recommended by the RBHA care manager/care coordinator are incorporated into the members care.
  • Coordinates transition of member care for PCP services into or out of the clinic setting.

Skills / Requirements

EDUCATION/LICENSE/CERTIFICATION/EXPERIENCE REQUIREMENTS

  • Completion of the applicable Registered Nursing course of study and degree.
  • Current licensure issued by the State of Arizona Board of Nursing as a Registered Professional Nurse.
  • Minimum of one year relevant experience; in a behavioral health setting preferred
  • Some assignments require a current Arizona Driver License and a current satisfactory 39-month Motor Vehicle Record (MVR)
  • Must be 21 years of age

Important Notes



Application Instructions