The Integrated Model for D-SNP team is focused on delivering an integrated member experience through a multidisciplinary team. Focused on the highest risk D-SNP members, this team coordinates both inbound and outbound customer and clinical service interactions. This is a unique opportunity to provide direct member care and help evolve the care model based on insights.

We are looking for an individual who is:

• Passionate about transforming our healthcare system to meet members’ rapidly evolving complex needs
• Dedicated to serving at risk populations most in need of additional supports
• Enthusiastic about working in an agile and fast-paced environment

Responsibilities

Working within an interdisciplinary care team thoughtfully orchestrated to support all aspects of members’ needs, the Behavioral Health Clinician is responsible for triaging cases referred for behavioral health and psychosocial support and implementing clinically indicated interventions.

Consistent with existing team-based care models, the Behavioral Health Clinician collaborates with all members of the Clinical Team including Care Coordinators, Registered Nurses, Pharmacists, and Community Health Workers to plan and implement optimal care for medically and psychosocially complex members. This includes both direct provision of care as well as referral to appropriate internal and external counterparts to facilitate the necessary services to support members’ overall health and wellbeing.

This position requires a comprehensive understanding of behavioral health diagnoses as well as chronic medical conditions, and how the two interrelate and affect one’s global health. Experience should include crisis management, psychosocial assessment, intake and triage decision making regarding levels of care, and time limited counseling. Knowledge of local community-based resources for behavioral health care is also needed.

As this is a newly developed care team, adaptability, flexibility, and willingness to participate in process and workflow improvement is vital to success in this role.

Major Duties and Responsibilities

• Support the implementation ongoing integration of behavioral health resources to IMD members
• Upon receiving a referral, the Behavioral Health Clinician will perform an assessment of the member’s symptoms, psychiatric treatment history, contributing medical conditions, social supports, caregiver concerns, barriers to accessing care including transportation or potential stigma/bias against receiving care. The clinician will then collaborate with members of the care team to prepare an intervention plan and create referral
• Serve as a source of knowledge on behavioral health diagnoses and recommended evidence-based treatments to primary care colleagues
• Complete referrals for behavioral health care as indicated to other team members such as the Pharmacist for virtual medication consultation, or to Community Health Workers for community-based providers
• File reports as mandated for suspected abuse and/or neglect of children, disabled persons or the elderly
• Work closely with Community Health Workers on the team, eliciting their assistance with barriers to wellness such as lack of transportation or food insecurity
• Act in accordance with the NASW Code of Ethics
• Performs other duties as required

Organizational Responsibilities

• Maintains patient confidentiality in accordance with HIPAA
• Demonstrates a desire and commitment to meeting member’s needs as well as improving their overall experience of interactions with the IMD Pilot
• Participates in supervision and continuing education to maintain Licensure
• Documents patient encounters in medical record system in a timely manner
• Follows general policies related to fire safety, infection control and attendance

Required Qualifications

• Master’s Degree in Social Work from an accredited institution
• Clinical Social Work Licensure (LCSW, LISW-CP) to work in the state Louisiana.
• 3-5 years of experience working in the mental health field preferred
• Experience working in medical social work or with the geriatric population preferred
• Advanced clinical assessment skills

Skill/Abilities/Competencies Required

• Ability to multi-task in a fast-paced work environment
• Flexibility to fluidly transition and adjust in an evolving role
• Excellent organizational skills
• Advanced oral and written communication skills
• Collaborative approach to patient care and strong interpersonal skills
• Compassion and desire to advocate for patient needs
• Critical thinking and problem-solving capabilities
• Competence in Microsoft Word, Excel and PowerPoint

Scheduled Weekly Hours

40