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