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SKILLS & COMPETENCIES REQUIRED: This section should be a bulleted list of minimum requirements explaining the skills (what the individual is trained for) and competencies (measurable as defined by the job) necessary to perform the job.
Knowledge skills and ability to assess patient need for services.
Knowledge of community agencies/resources.
Knowledge of specific medical/psychiatric illnesses procedures and treatments related medications (i.e. psychotropic) acuity versus chronicity
Comfort with a patientcentered approach that allows the patients desires around behavioral change to inform the plan of care.
Ability to advocate/negotiate systems for/with patients.
Ability to maintain effective working relationships with patients/families and staff.
Excellent interpersonal and written and verbal communication skills
Ability to work well in interdisciplinary teams including health care providers and office staff representatives from Primary Care Psychiatry Social Work and Population Health Management and to build collaborative relationships
Ability to work independently with minimal supervision
Excellent advocacy and collaboration skills
Excellent organizational skills
Strong computer and database skills
Maintains patient/family confidentiality
Massachusetts General Hospital is an Equal Opportunity Employer. By embracing diverse skills perspectives and ideas we choose to lead. Applications fromprotected veterans and individuals with disabilities are strongly encouraged.
PRINCIPAL DUTIES AND RESPONSIBILITIES: In order of importance list essential areas of responsibility major job duties special projects and key objectives for this position. These items should be evaluated throughout the year and included in the written annual evaluation. This section should be completed as a bulleted list and explain how the role is performed.
Responsibilities for DCARE requiring 75 of time include:
Screening/Assessment
Triage consultation requests from Primary Care Physicians and forward them to the appropriate DCARE
provider providing timely turnaround of information to primary care practices.
Coordination/Communication
Employing a range of interventions such as care coordination/case management risk screening and behavior change interventions information or referral and safety planning.
Research resources available for adults with behavioral health needs including but not limited to: outpatient individual orgroup therapy psychopharmacology partial hospital programs and inpatient programs and selfmanagement tools.
Effectively track and document calls and outcomes for reporting purposes.
Identify and refer to community services as indicated by consultation or communication with patient.
Communicate effectively with communitybased mental health providers in order to find the most accessible
Resources or patients taking into account coverage geography and availability.
Advocate on behalf of patients and their families to gain access to services and resources.
Assist Psychiatrist with follow up patient calls as recommended during consultation for coordination of care
needs
Provide backup for answering DCARE calls or emails as needed
Provide support with complex cases for Behavioral Health Support Specialists at Phase 2 practices as needed
Document all relevant information in the patients electronic medical record and DCARE management database in a timely fashion
Collaborate with the local and central behavioral health integration teams (including Medical Director and Program Manager at Partners Population Health Management) to identify areas of opportunity to improve integrated behavioral health management and achieve quality goals
Participate in practice outreach and educational presentations as needed
Complete other projects and duties as needed and specified by BHI Team and/or supervisor
Responsibilities of Care Coordinator requiring 25 of time include:
Screening/Assessment:
Provide psychosocial assessment on patientcare planning and patient/family management
Assist with crisis intervention when needed
Coordination/Communication:
Uses goaloriented skillsbased patient centered brief interventions provides ongoing patient contact as needed to
coordinate care and maintain treatment adherence
Demonstrates an understanding of the current and future needs of the patient in both chronic care and health
maintenance and is able to use decision making skills to help patients meet those needs
Participate in rounds case conferences to exchange information to improve patient care
Refers to and collaborates with Department programs outside agencies facilities payers and other relevant
community resources
Document all relevant information in the patients electronic medical record and DCARE management database in timely fashion
Professional Conduct:
Adhere to the professions clinical standards and Code of Ethics
Adhere to the Department and Hospital standards policies and procedures
Professional Development:
Participate in individual/group supervision as appropriate to level of licensure/professional development
Attend pertinent continuing education and professional activities related to job responsibilities and career goals.
Is responsible for own professional development. Attends pertinent continuing education and professional activities related to job responsibilities and career goals.
Keeps current with social work and health care development pertinent to job and profession.
Comply with licensure requirements.
Full-Time