Accompany Health is on a mission to give low-income patients with complex needs the dignified, high-quality care they deserve but rarely receive. A primary, behavioral, and social care provider, Accompany Health walks alongside patients for their entire care journey, offering at-home and virtual care, as well as 24/7 support. Partnering with innovative payors, Accompany Health is powered by remarkable care teams, elegant technology, and a commitment to evidence-based practice. 

We build long-term relationships with our patients so they know, without question, that our team is here for them day or night, year after year. We focus on the health outcomes most important to our patients to make it clear that they lead the way.

To achieve our mission, we collaborate with community-based organizations, local providers, and health plans. Led by our empathetic care teams, guided by proven care models, and powered by our own technology, we deliver a level of service that our communities rightfully deserve but rarely receive. 

While our headquarters is in Bethesda, MD, our teams are distributed across the country. If you’re eager to make a tangible difference in people’s lives, to help correct long-standing disparities in health care, join us. 

About the role:

Behavioral Health Clinicians (BHCs) are a key part of our Integrated Care Teams, which also include physicians, advanced practice clinicians, community health workers, patient experience navigators, social workers, Registered Nurses, psychiatrists, and pharmacists. Together this team is responsible for providing and coordinating holistic, patient-centered care for an intimate panel of patients with complex medical, behavioral health, and social needs in an in-home and community-based model.

As an Accompany Health Behavioral Health Clinician, you will care for patients primarily virtually via video, telephone, or text, but also in the home and community as needed. You will drive our Integrated Behavioral Health Services for mild/moderate mental health needs as well as substance use disorder in the Collaborative Care Model. In partnership with our psychiatrists, you will quarterback our Advanced Behavioral Health services for patients with complex serious mental illness and/or substance use disorder. You will also support the Integrated Care Team by ensuring a behavioral health perspective is incorporated into comprehensive care planning for complex patients. 

Responsibilities will include:

• Quarterbacking our integrated behavioral health service which closely aligns with the measurement-based treatment to target Collaborative Care Model, for patients with mild/moderate behavioral health needs including depression, anxiety, PTSD, and alcohol/opioid substance use disorders.
• Patients in this model are directly referred by our primary care team or identified via data analytics in our patient population to meet the above criteria. Our BH clinicians engage patients in our intervention and track patients in a registry to monitor treatment progression. The treatment plan focuses on measurement-based treatment to target (e.g. remission or reduction in symptoms). On average, patients graduate from the intervention in 6-9 months. 
• Duties of the BH clinician in this model include but are not limited to: outreaching and engaging referred/qualified patients, accepting (and at times initiating) warm handoffs from other team members, completing a clinical initial intake with in-depth psychosocial history and clinical diagnosis, formulating a comprehensive treatment plan in partnership with the psychiatrist, executing on the treatment plan in coordination with our primary care teams, delivering brief therapeutic interventions and short-term therapy, proactively monitor and track patients via a care registry to insure clinical improvement, and referring and navigating to community resources for access to the broader behavioral health continuum of care.
• Quarterbacking our Bridge Services model for patients with serious mental illness (e.g. schizophrenia, bipolar, etc.) and/or substance use disorder. Patients in our Bridge Services model receive short-term intervention (3-6 months) from our BH clinician and psychiatrist in order to stabilize and transition to long-term BH services in the community. 
• Supporting patients in transitions of care from facilities for admissions related to behavioral health diagnoses, including but not limited to: coordinating on discharge plans with inpatient care management, performing assessments to identify risk factors for readmissions, ensuring close follow-up and coordinating services.
• Assisting the clinical team in urgent triage for behavioral health related issues
• Participating in multi-disciplinary case conferences and clinical rounds to ensure holistic and appropriate care for patients.
• Providing formal and informal coaching and education to other clinical and non-clinical team members about supporting patients with behavioral health issues. 
• Supporting the emotional health and well-being of our multidisciplinary team through moderating group-based resilience sessions.
• Providing feedback on program design and workflows to ensure we are providing the best patient care possible.
• Ensuring timely and appropriate documentation.
• Roles and responsibilities may evolve as our care model develops. 

• Passionate about caring for complex, historically underserved patients with co-occurring chronic and behavioral health conditions in an integrated, multi-disciplinary model anchored in home-based and tech-enabled virtual care.
• Committed to providing the highest quality, outstanding clinical care to all patients, regardless of their needs.
• Consistently go the extra mile to ensure that our patients have the best healthcare experience possible.
• Excited to be a part of and contribute to the development of a rapidly evolving, innovative care model.
• Enjoys continuously learning and adapting workflows to improve patient care.
• Excellent communicator able to coach and mentor clinical and non-clinical members of multidisciplinary teams on excellent patient care. 

• Required
• LICSW, LCSW or LMHC with active license in the market in which you are applying.
• 5 years of experience in assessing, provisional diagnosis, planning, and managing behavioral patient care as acquired through clinical experience, including direct therapy and care management work.
• 2 years of experience working in high risk populations with serious mental illness and substance use disorder.
• Highly skilled in trauma-informed care and culturally sensitive care.
• Experience and comfort working within an interdisciplinary care team, and specifically closely collaborating with community health workers and primary care providers.
• Highly flexible and adaptable; enjoys learning new skills and contributing to ongoing learning and process improvement.
• Comfort with electronic medical record documentation and excited about how technology can support your work.
• Valid unrestricted driver's license and access to an insured vehicle for daily use

• Preferred 
• 1 years experience in Collaborative Care (CoCM) model.
• 2 years in care/case management role preferably in an ambulatory care or community service provider managing high risk populations with serious mental illness and substance use disorder
• Familiarity and comfort with DSM5 diagnostic criteria. 
• Experience in transitions of care management for patients discharging from behavioral health facilities or step-down units, including performing detailed medication reconciliation, patient education, and connection/navigation to appropriate services.
• Extensive knowledge of Medicare and Medicaid, state benefits and community resources for behavioral health needs in the local market.
• Experience as an active participant in continuous quality improvement projects.
• Proven experience in developing and sustaining internal and external client relationships with healthcare professionals, including community service providers. 

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For Patient Facing Roles

To keep our patients, communities and each other safe, you'll be required to comply with Accompany Health’s medical clearance requirements, including completing a TB screen and providing proof of immunity or vaccination for certain conditions. You will also be required to be vaccinated and up-to-date on your COVID-19 vaccinations, including boosters. This is a condition of employment, and we make exceptions as required by law. Accommodation for religious and medical beliefs will be provided on a case by case basis.

For Non-Patient Facing Roles

To keep our patients, communities and each other safe, you'll be required to comply with Accompany Health’s medical clearance requirements, including receiving the COVID-19 vaccine. This is a condition of employment, and we make exceptions as required by law. Accommodation for religious and medical beliefs will be provided on a case by case basis.

We embrace diversity and believe it creates a healthier atmosphere: Accompany Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.