Behavioral Health Integrated Navigator

STATUS: Non-Exempt, Full Time

IMMEDIATE SUPERVISOR: Director of Behavioral Health

SUPERVISORY RESPONSIBILITIES: None

FLEXIBLE WORK: Hybrid schedule option

PAY RANGE: $22.00-$30.50/hour

WHO YOU ARE:

YOUR ROLE & IMPACT

As part of a dynamic team at Charles River Community Health (CRCH), a healthcare practice providing compassionate care to underserved communities, the Behavioral Health Integrated Navigator will join a dedicated multidisciplinary team to provide comprehensive support services from the Behavioral Health Department to patients across the lifespan. The Behavioral Health Integrated Navigator will play a critical role in the coordination of Behavioral Health (BH) services, including effective communication with patients from diverse backgrounds, internal teams, external stakeholders, and the community.

YOUR RESPONSIBILITIES

• Work with BH to increase access and engagement with specialty mental health treatment, substance use treatment, and medical treatment.
• Increase follow up rates following hospital discharges by reviewing daily ADT feed and coordinating with discharge teams at local hospitals to schedule BH and medical appointments as needed.
• Assist with managing the In-House BH Referral List by reviewing the list on Mondays, and working with IBH clinicians and BH Director to triage and contact patients to schedule appointments and notify treatment team.
• Assist with recall list for patients who missed scheduled BH appointments or who screened positive for a BH issue.
• Work in collaboration with Community Health Worker department at CRCH to help provide community resources and outreach efforts to all active patients receiving BH services at the Health Center as needed.
• Work with C3 to connect CRCH patients with community partners programs, such as Behavioral Health Community Partners:
  • Serve as health center-based liaison between the Primary Care Team (PCT) and the BH Community Partners (CP).
  • Receive and manage BH CP-assigned members in Identifi Care.
  • Coordinate and document communication between BH CP and PCT.
  • Coordinate with each BH CP and the PCT with respect to the outreach, engagement, and care management of all BH CP-Assigned Enrollees assigned to that particular CP.
  • Facilitate PCT review and approval of the patient assessment and care plan.
  • Evaluate and triage ad-hoc referrals to the PCT and together determine whether it is appropriate to assign the referred enrollee to a BH CP.
• With the PCT, facilitate the process for managing requests from BH CP-Assigned or BH CP-Engaged Enrollees to switch CPs. Communicate these changes to the enrollee, Primary Care Team and former CP.
• Provide empowerment and advocacy to individuals and families across the lifespan to ensure that patients are engaging in treatment.
• Complete and document social determinant of health assessments for patients enrolled in BH as needed.
• Report to BH Team and document progress towards meeting the needs identified in the social determinants of health assessment.
• Network with local and surrounding agencies in the community to exchange information and resources, and provide referral and information to direct patients to needed services in the community.
• Work as a liaison between BH clinicians and patients to help identify appropriate specialty services outside of clinic.
• Facilitate and coordinate meetings as a liaison between the patient and the Health Center, as deemed appropriate by treating clinician.
• Collaborate with child welfare agencies, DYS, and DCF where there is identified probable cause of abuse or neglect.
• Explore barriers to treatment with high-risk patients to ensure compliance and adherence to health (Medical/Behavioral Health) care goals.
• Help patients navigate through the system to ensure that medical, behavioral health, and social needs are being addressed by assisting families to complete non-medical forms as needed.
• Maintain records and documentation of all patient contact activity and client data in the EHR in an accurate and timely manner.
• Keep track of referrals and meetings in Outlook calendar.
• Assist BH team in rescheduling no-show appointments on a weekly basis in order to help patients engage in treatment and reduce no-show rate.
• Participate in training programs and community outreach efforts that assist and promote effective patient services, as approved by supervisor.
• Participate in weekly Complex Care review team meetings and review charts prior to meetings in order to contribute to care plan updates (i.e. schedule dual/co-joint appointments for BH patients unable or unwilling to access care, provide updates about social determinants of health assessments findings, and make follow up calls to patients to confirm engagement with resources provided).

YOUR QUALIFICATIONS, COMPETENCIES, TRAITS

• Bachelors or Associates degree, or equivalent work experience required.
• 1 year of experience in patient care and care coordination experience preferred.
• Excel, Outlook and EHR experience preferred.
• Bilingual/bicultural in Spanish required.
• Must have strong communication skills with staff and patients from diverse cultures, whose primary language is not English.
• Must have ability to summarize and communicate in English moderately complex information, in varied written formats, with internal and external customers.
• Must have ability to comprehend and communicate complex verbal information in English with medical center staff, patients, families and external customers.
• Must have a willingness to work flexible hours to meet the organization's needs/demands.
• Must be able to travel to either Charles River Community Health site (Brighton and Waltham) as needed.
• Must have excellent communication skills, particularly with people from diverse cultures, with the ability to understand the community, population, and patients we serve.
• Must have experience in diverse cultures, with strong commitment to promoting Diversity, Equity, and Inclusion and reducing inequities.
• Must believe in the work we do at CRCH, with a strong passion to serve underserved populations in diverse settings.

WHO WE ARE AND WHAT WE DO

Charles River Community Health’s mission is to improve the health and well-being of the communities of Allston, Brighton, Waltham and surrounding areas by providing quality, compassionate, coordinated care that is patient-centered, family friendly, and community focused.

CRCH is a comprehensive practice providing medical, pharmacy, dental, behavioral health, optical, and vision services to diverse underserved local communities. We serve over 15,000 patients annually, and 80% of those served are well below the poverty line while over 60% speak in a language other than English.

We are committed to providing patients with timely access to the right care, at the right place and at the right time, collaborating with other organizations to connect patients with a comprehensive range of services and provide continuity of care, and creating new community partnerships to meet the changing needs of patients and the community.

We value caring for everyone with dignity, respect, and compassion, reducing cultural, financial and other barriers to care, and eliminating health care disparities for our patients. We also advocate for the needs of our patients, the community, and public health causes.

OUR PROMISE

If you are passionate about providing access to quality and compassionate care to the underserved, you will find your career rewarding and impactful. As Behavioral Health Integrated Navigator, you will be part of a dynamic and fast-paced team with a shared vision to breakdown barriers in delivering healthcare excellence!

OUR BENEFITS & PERKS

Medical & Dental Insurance

Short & Long-term Disabilty Insurance

Generous Paid Time Off

Flexible Spending Account

Employee Assistance Program

Tickets at Work

Health Reimbursement Arrangement

Travel Reimbursement

Professional Development Opportunities

Solid track record of developing and promoting employees internally!

Charles River Community Health is strongly committed to diversity and a workplace environment that respects, appreciates and values employee differences and similarities. By providing and supporting a work culture that fosters and builds upon diversity and its strengths, CRCH will better serve our local communities and continue to provide quality patient care and services. CRCH is an employment at-will organization and an equal opportunity employer committed to maintaining a work and learning environment free from discrimination on the basis of sex, race, color, religion, national origin, pregnancy, gender identity, sexual orientation, marital/civil union status, ancestry, place of birth, age, citizenship status, veteran status, political affiliation, genetic information or disability, as defined and required by state and federal laws. Additionally, CRCH prohibits retaliation against an applicant or employee because he or she has engaged in protected activity under the statutes prohibiting discrimination in the workplace.