Primary Job Functions:
Clinical Responsibilities
- Assists patient with paperwork including admissions, discharges, etc
- Coordinates care between healthcare providers and patient
- Ensure treatment providers have the results of screeners completed at intake and as indicated
- Demonstrates the ability to assess the consumer’s needs utilizing the SUN-R/HSNA
- Identifies goals and plans for appropriate services
- Provides appropriate linkage to community resources
- Monitors consumers to secure placement in the least restrictive environment
- Provides ongoing monitoring of consumers’ progress and needs as assessed in the SUN-R/HSNA
- Assists patients in connecting to primary healthcare
- Assists patients in connecting with benefits specialist
- Assists patients in connecting with appropriate therapists Assists patients in referrals to TCM, IPS, Day Programs
- Educates patients about their diagnoses, treatment options, and medications
- Provides emotional support throughout the healthcare process
- Facilitates communication between patients and healthcare teams
- Conducts follow-up after hospital admissions to ensure proper care coordination
- Connects patient with available community resources and services
- Advocates for patient to ensure high-quality care
- Helps patient overcome logistical barriers to accessing care to include assisting with transportation arrangements for medical appointments
- Participates in interdisciplinary care teams to support complex cases
- Maintains knowledge of community resources and healthcare programs
- Coordinates implementation of internal services
- Assesses social drivers of health to assist in reducing disparities
- Provides ongoing monitoring of consumers’ progress and needs with the patient
- Provides training of basic living skills to improve consumers' quality of life and to help enable them to be able to maintain in the least restrictive setting
- Evaluate the patient for needed changes in Risk Levels
- Evaluates the consumer for discharge planning
- Effectively collaborates with the treatment team members and outside sources in the delivery of case management services
- Effectively demonstrates the application of adult specific competencies
Supervision and Consultation
- Seeks clinical supervision and consultation as needed
- Accepts and employs suggestions for improvement
- Actively works to enhance care management skills
Clinical Record Keeping
- Document interactions with patients when needed
- Documents within Avatar appropriate follow-up and provision of linkage to services.
Courteous and respectful attitudes towards patients, visitors, and co-workers
- Treats patients with care, dignity, and respect
- Respects patient’s privacy and confidentiality
- ; Is pleasant and cooperative with others
- Personal values don’t inhibit the ability to relate and care for others sensitive to the patient’s needs, expectations, and individual differences
Case Load Management:
- Effectively manages caseload based on patient needs and staffs with supervisor regularly
- Meets AltaPointe productivity standards
Administrative and Other Related Duties as Assigned:
- Actively participates in Performance Improvement activities
- Actively participates in AltaPointe committees as required
- Follows AltaPointe policies and procedures
- Attend to required in-service training and other workshops