Counselor-Primary Care Advanced Care Manager (2551)

REPORTS TO: Director of Primary Care Behavioral Health
EDUCATION & EXPERIENCE: Master’s degree in social work, public health or administration, or any related field, or bachelor’s degree with commensurate experience in these fields
SKILLS:

•  Basic understanding of chronic care management and primary care systems
• Ability to navigate health care systems
• General knowledge of chronic health care conditions and needs
• Ability to communicate across disciplines
• Familiarity with coordinating support services for patients
•  Excellent written & verbal communications
• Bilingual (English/Spanish) ability is preferred and reflected in compensation
   

PRIMARY DUTIES:
Implement and support care management for patients with medical and behavioral disorders.
Coordinate with primary care teams, and collaborate with community partners to address unmet needs for at-risk patients.
Provide problem-solving assistance and decision-support to primary care teams implementing care management.
Perform advanced care management tasks including pre-visit planning, providing patient education, monitoring registries and supporting patient self-management
Provide care coordination services to address short- and long-term medical and behavioral health treatment goals
Communicate with physician and care team members about relevant patient needs or changes
OTHER DUTIES:
Other duties as assigned by supervisor
PHYSICAL AND MENTAL REQUIREMENTS:
Visual and auditory accuracy
Shift length - 8 hours
Indoor setting
Frequent use of computer
Long periods of sitting
Frequent use of telephone
Continuous repetitive grasping and manipulation of both hands
Continuous conversational communication
Occasional reaching, walking, squatting, bending, kneeling, twisting and climbing
Occasionally carrying, lifting, pushing and pulling of up to 25 lbs.
Occasionally working in confined, noisy, dusty areas
Periodic use of personal transportation
Understand/carry out simple/detailed, oral/written instructions with retention
Read and interpret detailed specifications