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Nurse Care Coordinator
Job Code:12741
Location:Saco 04072
Department:Behavioral Health Home
FT/PT Status:Full Time
  
Summary:

The Nurse Care Coordinator shall provide regional primary care consultation, psychiatric care consultation; work with the Behavioral Health Home Organization (BHHO) & Certified Community Behavioral Health Clinic (CCBHC) team, Child Assertive Community Treatment Team, Private Non-Medical Institute, and other members to facilitate care across the healthcare continuum.


$10,000 sign-on Bonus!
Pay starts at $33/hour!

ESSENTIAL FUNCTIONS:

  • Provide education and support around medications to the Interdisciplinary Team (IDT), members, and families.

  • Provide medical education about chronic disease management to IDT members, families and groups.

  • Liaison to Health Home, ACT Teams, CCBHC Practices/Primary Care Physicians.

  • Collaborate with the IDT on member plan of care.

  • Review Health Questionnaire and provide recommendations to IDT and/or members and families for medically compromised participants.

  • Assist, and/or make recommendations regarding skill development in activities of daily living, including hygiene, nutrition, exercise, general health maintenance/improvement.

  • Support implementation of grant funded projects such as In-Shape, CTI, and other health and wellness pay for performance initiatives in geographical area where program is offered.

  • Support Behavioral Health Home team, CCBHC and Child ACT in achieving organizational and state required outcomes, including but not limited to A1C testing, tobacco screening and annual health screenings.

  • Be proficient in EHR, HIN, and VMS systems in order to extract clinical data and alerts in order to support level of care.

  • Consult with IDT and members as indicated regarding discharge planning recommendations and follow up.

  • Monitor emergency department usage and coordinate with IDT and other providers to promote least restrictive level of care.

  • Medication reconciliation through EHR from external providers (i.e. PCP, Specialists, etc.) when appropriate.

  • Provide medication and medical education to Interdisciplinary Team (IDT), members, and families.

  • Complete pharmacy enrollments, medical equipment orders, and other supports/services to support recovery goals.

  • Provide CRMA Training and Supervision as needed.

  • Schedules will vary according to program needs (as applicable):

  • On-call responsibilities as assigned



GENERAL EXPECTATIONS:

  • Provide excellent customer service

  • Active participation in supervision of student interns, as appropriate and needed.

  • Ensure the confidentiality of all patient information and release of information from area(s) of responsibility.

  • Ability to support and recognize the important role volunteers play.  Sweetser employees work with, support, collaborate with volunteers, and promote opportunities for volunteer engagement

  • Exercise judgment consistent with clinically accepted standards of community practice in determining whether to transport a particular patient(s).

  • Maintain adequate personal vehicle insurance coverage, a valid state driver’s license, a vehicle that is in good repair and a good driving record as per organization policy.

  • Active participation in required supervision as determined with Program Manager according to licensure level.

  • Timely and accurate provision of administrative paperwork according to the time frame established by the organization’s policies.

  • Active participation in administrative meetings, including program meetings and general staff meetings.

  • Understand and comply with all Sweetser policies and procedures as identified in the Human Resources Policy Manual.

  • Maintain administrative responsibility (charting/documentation, etc.)

  • Active participation in in-service training and continuing education programs.

  • Active participation in providing community education to staff, community groups, etc., as appropriate and needed.

  • Maintain minimum number of training hours mandated by professional licensure and required by state licensing.

  • Maintain relationships with patients that promote dignity, equality and self-determination.

  • Provide productive and supportive collaboration with peers/colleagues in the same program and across programs.

  • Maintain productive and efficient relationships with all organization-wide personnel and programs.

  • Maintain positive representation of the organization, at all times, with the public.

  • Follow Suicide safer care practices.

  • Other duties as assigned.

EDUCATION:

  • Graduate from an accredited school of nursing. 

CERTIFICATES, LICENSES, REGISTRATIONS:

  • Current RN license in the State of Maine.

  • Maintain a valid state driver’s license.

  • Must be able to speak, read, and write English fluently. 

EXPERIENCE:

  • Previous experience working with adults with serious and persistent mental illness preferred.