General Description

Denton County MHMR Center employees are to be committed to fostering an open, inclusive, and supportive environment that welcomes and embraces diversity in all forms. Denton County MHMR Center defines diversity broadly to include race, ethnicity, abilities (mental/physical), gender, gender identity, immigrant status, language, religion, sexual orientation, socioeconomic status, veteran status, age, and other groups.

Denton County MHMR Center employees are to strive to maintain a trauma sensitive workplace, to embrace trauma sensitive and informed practices, and to foster a supportive and welcoming environment of care.

Under direction of the Center Assistant Medical Director, Chief Medical Office, Chief Executive Officer and within federal, state, and local guidelines performs quality psychiatric clinical work. This position reports to the center Assistant Medical Director except for scheduling time off, training, and general program related matters which is coordinated by Clinic operations Director in collaboration with the center Assistant Medical Director. Work involves assessing, planning, and providing comprehensive patient care independently or in collaboration with other health care professionals.

Provide Psychiatric services in the Denton County MHMR Center outpatient clinics, Crisis services and various center sponsored programs. Provide evaluations, medication management, diagnostics, and plan of care recommendations to clients with acute and persistent mental illness. Provides both crisis and regular services. Services may be provided face to face, by telephone, or by telemedicine. The PMHNPl Serves as a member of the treatment team and works collaboratively with nursing, case management, care coordination and Crisis Staff. Works under minimal supervision, with extensive latitude for the use of initiative and independent judgment.

Education, Training and Experience (including licensure and certification)

Graduation of an approved accredited school of nursing; Master of Science in Nursing and approved as an Advanced Practice Registered Nurse by the Board of Nurse Examiners for the State of Texas is required. Board Certification as a Psychiatric Mental Health Nurse Practitioner (PMHNP) with the training and ability to provide psychiatric services across the lifespan. Prior experience with dual diagnosis (Developmental Disabilities/Substance Abuse and Mental Illness) and prior experience with Child and adolescent preferred.

REGISTRATION, CERTIFICATION, LICENSURE OR OTHER QUALIFICATIONS:

• Authorized by the Board of Nurse Examiners for the State of Texas for Advanced Practice Nurses Limited Prescriptive Authority with a valid prescription authorization number.
• Current Registered Nurse in the State of Texas license without restrictions

• Must maintain current licensure including DEA.
• All job specific training must be completed within 30 days of hire.
• Must maintain a valid Texas driver's license, auto liability insurance and a driving record acceptable to the Centers insurance requirements.
• Maintain current CPR certification
• Must be willing to precept nurse practitioner students.
• Excellent written and verbal communication skills.
• Strong organizational skills.
• Ability to work with and treat individuals with sever and persistent mental illness and individuals with addiction challenges.
• Must be willing to take on-call shifts if assigned.
• Willing to collaborate with delegating physician or designee.

Knowledge, Skills, and Abilities

• Knowledge of psychiatric principles and methods; of methods and procedures in general medicine; and of the principles and practices in the development, implementation, and documentation of individualized care and treatment plans.
• Skill in the care and treatment of patients, in the use of medical and psychiatric diagnostic and treatment tools and equipment, in conducting psychiatric research, and in the operation of computers and applicable computer software.
• Ability to examine, diagnose, and treat mental disorders; to interpret psychological diagnoses and analyses; to communicate effectively; and to assign and/or supervise the work of others.
• Working knowledge of computers, proficiency in typing to be able to document in a timely and efficient manner, ability to use and document in center's Electronic Health Record System.
• Ability and skills needed to provide services using Telepsych modality.
• Ability and skills to use instant messaging system.

Essential Duties

Provides psychiatric evaluation, diagnostic, and medication management services to adult clients and if assigned to C & A clients according to applicable Texas Administrative Code, as outlined in the DCMHMR policies and procedures.

• Conducts psychiatric evaluation and medication management services. Explores and takes into account all relevant data sources in conduction and formulating diagnosis. Service note includes appropriate clinical and other details to substantiate diagnosis and treatment decision making.
• Record the results of a primary evaluation and diagnosis in the clinical record and on the approved diagnostic tool using guidelines from current contract approved Diagnostic and Statistical Manual of Mental Disorders.
• Completes documentation as per center documentation guidelines and preferably on the same day for continuity of care and communication of care provided. All required elements in the service note are filled out.
• Service note reflects appropriate details for CPT billing code Selected.
• Diagnosis updates are done at least annually and additionally as necessary.
• Monitors vitals as appropriate.

Orders lab studies as recommended by prescribing guidelines and according to the DCMHMR Standing Lab Orders.

• Appropriate labs are ordered, available labs are reviewed appropriately when prescribing psychotropic medications.
• Reviews and signs off lab results in timely manner.
• Addresses abnormal lab values appropriately and in a timely manner.

Prescribes medications and maintenance treatment to clients assigned to the individual doctor's and APRN's caseload and in emergency situations to those on other Denton County MHMR prescriber's caseloads.

• Medications will be prescribed appropriate to the diagnosis and according to the appropriate HHSC approved medication treatment guidelines and documented on the DCMHMR Clinical Record Form.
• Informed psychotropic medication consent is obtained from Clients or LAR ( Legally authorized Representative) and documented. AIMS done appropriately and as per TAC guidelines.
• Will monitor and make recommendations regarding lab studies, according to the Denton County MHMR Standing Lab Orders and Abnormal Lab Value procedure.
• Avoid the use of polypharmacy and document clinical justification if required, following the DCMHMR Policies and Procedures regarding polypharmacy.
• Documents appropriately rational for prescribing and changes in the medication.
• Works cooperatively with the client using recovery-based language and incorporates the client's preferences for treatment when clinically appropriate.
• Patient and family education will be completed at each visit according to the Patient and Family Education (PFEP) program requirements and documented in the service note. This education will include information regarding diagnosis, treatment options, prescribed treatment, and recovery through self-monitoring and self-management.
• Will monitor and make recommendations regarding lab studies, according to the Denton County MHMR Standing Lab Orders and additionally as clinically indicated and, as per abnormal Lab Value procedure.
• Consults with delegating physician when a Certificate of Medical Examination is needed and arranges a face-to face meeting for the client and the physician as soon as possible.

Serves as a member of the treatment team and makes recommendations for plans of care.

• Seek consultation from the delegation physician or designee, Assistant Medical Director and Psychiatric Peer Team on difficult cases and document this consultation.

Refers clients to appropriate medical and community resources documenting this in the plan of care, eliciting assistance from case management, care coordination team and nursing staff.

• Provides consultation and orders regarding treatment, to the RNs and LVNs, regarding clients on other center prescriber's individual caseload or when a client's treating physician or APRN is not available for consult. Sign verbal orders/ GMO in a timely manner at the next available opportunity.
• Reviews each RN assessment at the client's next appointment when the RN is working under Standing Orders and provides suggestions or corrections as needed.
• Participates in Peer Review when applicable.
• Completes client care related paperwork appropriately and in timely manner.

Provides crisis care to new adult or C & A clients referred by crisis teams as well as crisis services to existing adult or C & A clients.

• Provides care to Adult or C & A clients over 14 years of age. For children under 14, care or consultation can be provided by APRN if agreed by delegating physician and approved by CMO ( Chief medical officer ) or designee..
• Participates in telephonic on call rotation is assigned. Provides consultation to RNs and Crisis Residential Unit nursing as well as QMHP staff for medication treatment and other recommendations for existing as well as new clients being served by the crisis teams and Crisis Residential Unit clients.
• Provides crisis services during regularly scheduled hours.

Provides and documents each service according to rules and regulations outlined by the Nursing board, Medical Board, DCMHMR, the State Pharmacy Board, HHSC,, and TAC.

• Each note must contain the required elements for Medicaid or other third-party billing and must be completed at the time of service.
• The attending PMHNP will help facilitate filling out documents for disability benefits, prescription assistance programs, prior authorization approval, FMLA and other necessary documents when requested.
• The PMHNP is to maintain consumer confidentiality and ethical standards at all time.

Practices workplace safety procedures.

• Adheres to the use of Universal Precautions.
• Adheres to the Center Infection Control Plan.
• Informs appropriate staff of any safety hazard or issue promptly.

Attends regularly scheduled meetings.

• Attends regularly scheduled staff meetings.
• Attends regularly scheduled staff trainings.
• Attends regularly scheduled committee meetings.
• Attends regularly scheduled clinical team meetings.
• Meets with delegating physician as required by appropriate governing body and Seeks consultation

Provides emergency intervention when necessary, according to Department of Human Services (DHS) and Center rules and procedures.

• Provides verbal and physical Prevention Management of Aggressive Behavior (PMAB) intervention correctly when necessary.
• Provides Cardiopulmonary Resuscitation (CPR) in an emergency until other medical aid arrives.
• Provides emergency and non-emergency first aid until professional medical aid arrives or as directed by licensed medical professional.
• Maintains all emergency intervention training according to Denton County MHMR (DCMHMR) policies and procedures.

Provides courteous, professional services at all times.

• Provides appropriate customer service and demonstrates cultural sensitivity and cultural awareness.
• Supervise and delegate prescriptive authority to APRN
• Performs additional duties as assigned by Assistant Medical Director or CMO ( Chief Medical officer) within designated timeframe.
• Demonstrates leadership, teamwork, dependability, and customer service.
• Is available and approachable for consultation to nursing staff.
• Demonstrates willingness to work in walk- in clients and crisis clients.
• Works collaboratively with case managers and other treatment team members.
• Demonstrates ability to work with others to identify opportunities and resolve issues to achieve common goal.
• Takes initiative and provides input towards the solutions. Manages time effectively, prioritizes, effectively utilizes increments of time, and maintains productivity. Assures appropriate
• performance standard related data is entered into service notes.
• Continually follows guiding principles and this is reflected in their job performance.

Accepts work assignments willingly, seeks clarification and prioritization from supervisor, as necessary.