Community Liaison

Description

Position Summary:

Responsible for the coordination and implementation of case management strategies pursuant to the continuous care from outpatient admission and following discharge. Assisting patients and family members in monitoring follow-up care. To serve as a member of interdisciplinary team supporting the organization's treatment program and philosophy and assure the deliverance of quality treatment to patients and their families. Participates in performance improvement activities. Attends 80% of staff meetings. Coordinates care for patients through communication with Physicians and Nurse Practitioners, hospital departments, and community services. Attends treatment team meetings as scheduled. Responsible for New Castle County Territory

Position Responsibilities:

Clinical / Technical Skills (40% of performance review)

• Initiates outpatient program orientation with patient to discuss plan of care
• Monitors cases while in outpatient.
• Coordinates with community resources to ensure continuous care following discharge from program.
• Assist the patient and family members in navigating community resources following discharge.
• Provides initial and ongoing updates and communication to schools and others involved in the patient’s care a minimum of at admission, discharge and once every 2 weeks.  Some patients or contacts may require more frequent communication.
• Assists in coordination of step downs from inpatient hospitalization.
• Provides groups as appropriate for the program.
• Evaluates patient care plans on a regular basis and updates the care plans when needed.
• Faxes aftercare plans to referrals within 24 hours of discharge.
• Will assist in UM process as appropriate.
• Will contact patients to encourage participation in programming.
• Will obtain consents and other documents as appropriate.
• Plans patient care in collaboration with all members of the healthcare team.
• Consults with other departments, as appropriate, to collaborate in patient care and performance improvement activities. 
• Collaborates with other departments to identify operational problems and develop solutions/resolution.
• Works with all members of the healthcare team to assure a collaborative approach is maintained in care and treatment of the patient.
• Works closely with therapist to integrate psychosocial management of patient/family needs.
• Attends treatment team, coordinates care plan with patient, provider, therapist and RN.
• Initial discharge plan formulated and noted on psychosocial assessment form within 72 hours of admission
• Participates in education on and implementation of clinical guidelines and protocols.
• Documentation meets current standards and policies.
• Maintains optimal continuum of patient care through efficient and effective planning, assessing and coordination of healthcare services.
• Demonstrates an ability to be flexible, organized and function under stressful situations.
• Maintains a good working relationship both within the department and with other departments.
• Develops and coordinates an individualized discharge plan for the patient by utilizing treatment team and written chart information to determine the patient's aftercare needs. 
• Accesses by phone or written correspondence family or community resources such as nursing homes, group homes, or private mental health practitioners to meet patients' aftercare needs.
• Coordinates with team members to incorporate discharge planning in all phases of patient care by discussing written progress notes from charts and communicating any state or local agency legal requirement for referral/discharge planning with the interdisciplinary team.
• Documents treatment provided to patient in medical record.
• Performs other duties as assigned.

Safety (15% of performance review)

• Strives to create a safe, healing environment for patients and family members
• Follows all safety rules while on the job.
• Reports “near misses”, as well as errors and accidents promptly.
• Corrects minor safety hazards.
• Communicates with peers and management regarding any hazards identified in the workplace.
• Attends all required safety programs and understands responsibilities related to general, department, and job specific safety.
• Participates in quality projects, as assigned, and supports quality initiatives.
• Supports and maintains a culture of safety and quality.

Teamwork (15% of performance review)

• Works well with others in a spirit of teamwork and cooperation. 
• Responds willingly to colleagues and serves as an active part of the hospital team.
• Builds collaborative relationships with patients, families, staff, and physicians.
• The ability to retrieve, communicate, and present data and information both verbally and in writing as required
• Demonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word. 
• Demonstrates adequate skills in all forms of communication.
• Adheres to the Standards of Behavior

Integrity (15% of performance review)

• Strives to always do the right thing for the patient, coworkers, and the hospital
• Adheres to established standards, policies, procedures, protocols, and laws. 
• Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence.
• Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources.
• Completes required trainings within defined time periods, as established by job description, policies, or hospital leadership
• Exemplifies professionalism through good attendance and positive attitude, at all times.
• Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws.
• Ensures proper documentation in all position activities, following federal and state guidelines.

Compassion (15% of performance review)

• Demonstrates accountability for ensuring the highest quality patient care for patients.
• Willingness to be accepting of those in need, and to extend a helping hand
• Desire to go above and beyond for others
• Understanding and accepting of cultural diversity and differences

Qualifications

Education:

• Required: High school diploma or GED.  CPR and hospital-selected de-escalation technique certification.
• Required: Bachelor degree in a behavioral health field.
• Maintains education and development appropriate for position.

Experience:

• Required: Three (3) years of related experience
• Preferred: Three (3) years of direct case management experience.