Job Summary

This role is a core member of the integrated care team. This role provides short-term, individualized clinical interventions to members who have been identified as seeking therapy and as having a behavioral health condition (e.g., substance use, depression, anxiety, schizophrenia, bipolar) that is negatively impacting their overall health and/or daily functioning. This role is centered in a trauma informed care approach with emphasis on harm reduction and motivational interviewing to elicit behavioral change and adherence with medical recommendations and treatment plans. 

This role serves as the behavioral health subject matter expert (SME) within an interdisciplinary care team comprised of primary care providers, nurses, medical/social work care managers, psychiatrists, pharmacy, community health workers, and resource specialists. The BHC may make for behavioral health levels of care that are not provided through AbsoluteCare providers, e.g., ACT, IOP, PHP, residential treatment, inpatient services.

The BHC comprehensively assesses our members through a biopsychosocial approach and develops a person-centered treatment plan with measurable goals toward improving the physical and behavioral health of our members. The BHC may provide any combination of short-term individual therapy, group therapy, and post-hospital follow up within 7 days of a member’s discharge from an inpatient mental health or substance use unit (HEDIS measures).

Key performance indicators used to identify success in improving the overall health of our members include meeting treatment plan goals, increased adherence to treatment plan compliance, decreased preventable medical/psychiatric events, (e.g., emergency room utilization, hospital admissions, and hospital readmissions), post hospital discharge follow up measures (HEDIS), and member retention.  The BHC promotes the mission, vision, and values of AbsoluteCare in all member and multidisciplinary team interactions. 

Duties and Responsibilities

• Provide individual, group, post discharge follow up behavioral health therapy that includes comprehensive biopsychosocial assessments, individualized treatment plans using SMART goals, timely clinical documentation (e.g., SOAP notes), and tracking progress of each goal to completion.
• Directly or in collaboration with other staff members, provide crisis intervention and de-escalation for members presenting in a crisis situation (via telephone or in person), including suicidality, disruptive and/or threatening behaviors, and disposition as clinically appropriate.
• Serve as the clinical behavioral health SME within the interdisciplinary care team (ICT) by providing recommendations, referrals, and follow up for behavioral health aspects of member care.
• Provide and advocate for clinical care using evidence-based approaches including trauma informed care, harm-reduction, motivational interviewing, cognitive-behavioral therapies, etc.; may include providing short-term solutions-based therapy or emotional management (e.g., anger management)
• Serve as a BH SME by demonstrating the use of trauma informed care and motivational interviewing in member interactions and staff trainings.
• Maintain close communication with PCP and psychiatrist for all members seen for therapy
• Complete documentation of patient care services in electronic health records within 3 business days of interaction.
• Develop and/or support individual treatment plans for members with chronic mental illness including Schizophrenia, Bipolar, Depression, Anxiety.
• Recognize opportunities and promote the use of long acting injectables, as appropriate, to support adherence to treatment plan goals.
• Responsible for scheduling appointments and promoting attendance which may include appointment reminder calls, identifying and resolving barriers to attendance (e.g., transportation), and follow up calls after missed appointments.
• In collaboration with clinical leadership, develop and maintain group therapy curriculum appropriate to the member population to include both educational and process components, e.g., grief, anger, anxiety, aftercare, overall health/wellness, tobacco cessation, etc.

Minimum Qualifications

• Clinically licensed in the state of practice with 3+ years of experience in a behavioral health related field including social work, mental health, and/or addiction.
• Licenses must allow for clinical practice and may include: LCSW, LPC.
• 2+ years of experience in a community mental health center, FQHC, inpatient psychiatric facility or other setting that serves clientele with complex behavioral health needs.
• Experience with complex government-sponsored populations preferred, e.g., Medicaid, Medicare beneficiaries.
• Experience with member engagement, transitions of care, interdisciplinary clinical care, and/or case management preferred.
• Telehealth experience preferred.
• Excellent clinical judgment and ability to independently manage a caseload
• Advanced computer skills with proficiency in Outlook, Word, Power Point, Excel.
• Excellent written and oral communication skills, including the ability to modify communication to the member’s needs/comprehension level.
• Experience working in multiple electronic health records.
• Excellent organizational and time management skills to triage and prioritize patient needs.
• Proven ability to work within a fast-paced, dynamic environment.
• Active CPR certification

About AbsoluteCare

At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into members: people who are entitled to some of the best, most focused care this country has to offer. We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make the most important services available to our members under one roof. This includes a pharmacy, X-rays, a blood lab, nutrition services, urgent care, and much more. We don’t stop at our four walls. We engage members in the communities where we all live to find the people who need us most. Through these community care teams, we remove the barriers to healthcare that so many people face daily. And it works. Our unique care is guided by our core values of accountability, caring, trust, and teamwork. We call it ACT2.

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