Care Navigator

AltaPointe Health Systems; Mobile (AL); On-site; USD 42,000 - 60,000; Full time

Job summary

AltaPointe Health Systems is seeking a care coordinator to assist patients with admissions, discharge planning, and care coordination across providers. The role involves connecting patients to primary care, benefits specialists, and internal programs, and educating patients about available services.

Responsibilities include maintaining comprehensive clinical records, participating in interdisciplinary teams, and supporting care transitions within AltaPointe's network.

Qualifications

• Bachelor's degree in a mental health discipline preferred; high school diploma acceptable.
• Knowledge of psychiatric disorders and cultural diversity.
• Ability to coordinate care and connect to services.

Responsibilities

• Assist patients with admissions, discharges, and paperwork.
• Coordinate care between healthcare providers and patient.
• Ensure treatment providers have screeners results at intake and as indicated.
• Assist patients in connecting to primary healthcare and benefits specialists.
• Assist patients in referrals to internal programs and therapists.
• Educate patients regarding services available and resources.
• Participate in interdisciplinary care teams to support complex cases.
• Document interactions and follow-up in clinical records.
• Provide ongoing monitoring of progress and needs, adjust plans as needed.
• Support performance improvement activities and AltaPointe committees.

Job description

• Assists patient with paperwork including admissions, discharges, etc
• Coordinates care between healthcare providers and patient
• Ensures treatment providers have results of screeners completed at intake and as indicated
• Assists patients in connecting to primary healthcare
• Assists patients in connecting with benefits specialist
• Assists patients in connecting with appropriate therapist
• Assists patients in referrals to TCM, IPS, Day Programs, Residential Programs, ACT, and any other internal programs needed
• Assists in ensuring treatment team has information needed during Huddle
• Provides support and assistance throughout the healthcare process
• Facilitates communication between patients and healthcare teams
• Conducts follow up after hospital admissions to ensure proper care coordination
• Connects patient with available community resources and services
• Helps patient overcome logistical barriers to accessing care to include assisting with transportation arrangements for medical appointments
• Participates in interdisciplinary care teams to support complex cases
• Coordinates implementation of internal services
• Assesses social drivers of health to assist in reducing disparties
• Provides ongoing monitoring of consumers' progress and needs with the patient
• Evaluates the patient for needed changes in Risk Levels
• Updates CCBHC Client Treatment Plan

Primary Job Functions

• Assists patient with paperwork including admissions, discharges, etc
• Coordinates care between healthcare providers and patient
• Ensures treatment providers have results of screeners completed at intake and as indicated
• Assists patients in connecting to primary healthcare
• Assists patients in connecting with benefits specialist
• Assists patients in connecting with appropriate therapist
• Assists patients in referrals to TCM, IPS, Day Programs, Residential Programs, ACT, and any other internal programs needed
• Educates patient regarding services available
• Assists in ensuring treatment team has information needed during Huddle
• Provides support and assistance throughout the healthcare process
• Facilitates communication between patients and healthcare teams
• Conducts follow up after hospital admissions to ensure proper care coordination
• Connects patient with available community resources and services
• Helps patient overcome logistical barriers to accessing care to include assisting with transportation arrangements for medical appointments
• Participates in interdisciplinary care teams to support complex cases
• Coordinates implementation of internal services
• Assesses social drivers of health to assist in reducing disparties
• Provides ongoing monitoring of consumers' progress and needs with the patient
• Evaluates the patient for needed changes in Risk Levels
• Updates CCBHC Client Treatment Plan

Supervision and Consultation

• Seeks clinical supervision and consultation as needed
• Accepts and employs suggestions for improvement
• Actively works to enhance care management skills

Clinical Record Keeping

• Documents interactions with patients when needed
• Documents within AVATARNx appropriate follow up and provision of linkage to services.

Courteous and respectful attitudes towards patients, visitors and co-workers

• Treats patients with care, dignity and respect
• Respects patient's privacy and confidentiality
• Is pleasant and cooperative with others
• Personal values don't inhibit ability to relate and care for others
• Is sensitive to the patient's needs, expectations and individual differences

Case Load Management

• Effectively manages caseload based on patient needs and staffs with supervisor regularly

Administrative and Other Related Duties as Assigned

• Actively participates in Performance Improvement activities
• Actively participates in AltaPointe committees as required
• Follows AltaPointe policies and procedures
• Attends to required in-service training and other workshops

Bachelor's degree in a mental health discipline preferred, high school diploma or equivalent.

Knowledge as outlined below, to be attained within six (6) months of employment

• Knowledge of psychiatric disorders in the adult population
• Knowledge of developmental disabilities in the adult population
• Knowledge of substance use issues in the adult population
• Knowledge of chronic medical condition in the adult population
• Knowledge of cultural diversity
• Knowledge of behavior management and crisis intervention
• Knowledge of available community resources and internal services