Behavioral Health Care Manager

OHSU Family Medicine at Richmond is designated as a Federally Qualified Health Center (FQHC) and cares for over 16000 community members as a part of the community safety net. Some applicants may qualify to apply for student loan repayment due to FQHC designation.

The behavioral health care manager (BHCM) position is a behavioral health provider who operates in the Collaborative Care Model (CoCM) as part of our integrated behavioral health teams. The behavioral healthcare manager is a core member of the CoCM team including the patients medical provider (primary careprovider or referring specialty provider) and psychiatric consultant traditional health care worker (THW) ifavailable as well as the larger clinic team to ensure continuity of BHCM is responsible for supporting and coordinating the mental and physical health care of CoCMpatients on an assigned patient caseload with the patients primary care provider and the CoCM psychiatricconsultant. When appropriate the BHCM may also coordinate care with other internal and external mentalhealth providers.

This position involves a high degree of clinical complexity and advanced level of skill in delivering evidence-based interventions targeted to improve wellbeing and health for a large variety of patients with emotional and behavioral concerns commonly seen in a primary care setting. The work includes screening and assessing patients for common mental health and substance use disorders providing education about these conditions discussing available treatment options and facilitating patient engagement and follow-up care. The BHCMalso is responsible for systematically tracking treatment engagement and response (via a registry) and for monitoring patients (either in person by phone or virtual visit) for changes in clinical status and treatment side effects or complications. The BHCM supports the patient in their management of their psychotropicmedication focusing on treatment adherence monitoring side effects and effectiveness of treatment.

Additionally the BHCM provides brief behavioral interventions using evidence-based techniques such as behavioral activation problem-solving therapy motivational interviewing and other treatments as appropriate. The role also involves participation in regular (weekly) caseload consultation with the psychiatric consultantand communication of resulting treatment recommendations to the patients continuity medical provider.

Counseling:

• Provide brief behavioral interventions using evidence-based techniques such as behavioral activation problem-solving treatment motivational interviewing or other treatments asappropriate.
• Support the patient in their psychotropic medication management as prescribed by medical providers focusing on treatment adherencemonitoring side effects and effectiveness of treatment.
• Provide or facilitate in-clinic or outside referrals to evidence-based psychosocial treatments (e.g. problem-solving treatment or behavioral activation) as clinically indicated.
• Support the mental and associated physical health care needs of patients on an assigned patient caseload. Closely coordinate care with the patients continuity medical provider and when appropriate other mental health providers.

Psychosocial Assessment:

• Screening and assessment of patients for common mental health and substance use disorders. Facilitate patient engagement and follow-up care.
• Provide patient education about common mental health and substance abuse disorders and the available treatment options.

Patient Services

• Systematically track treatment response and monitor patients (in person or by telephone or virtual visit) for changes in clinicalsymptoms and treatment side effects or complications.
• Manage collaborative care registry.
• Facilitate referrals for clinically indicated services outside of the organization (e.g. social services such as housing assistancevocational rehabilitation mental health specialty care substanceabuse treatment).
• Facilitate treatment plan changes for patients who are not improving as expected in consultation with the medical provider and thepsychiatric consultant and who may need more intensive or morespecialized mental health care.
• Systematically track treatment response and monitor patients (in person or by telephone or virtual visit) for changes in clinicalsymptoms and treatment side effects or complications.

Documentation:

• Document patient progress and treatment recommendations in the electronic health record (EHR) and other required systems to beshared with medical providers psychiatric consultant and othertreating providers.
• Track patient follow up and clinical outcomes using a registry. Document in-person and telehealth encounters in the registry anduse the system to identify and re-engage patients.
• Develop and complete relapse prevention self-management plan with patients who have achieved their treatment goals and are soonto be discharged from the caseload.

• A Masters Social Work (MSW) required. Health care experience preferred.

• Certificate of Clinical Social Work Associate (CSWA) or Licensed Clinical Social Worker (LCSW) required for employees who practice clinical social work.

• Must possess a valid motor vehicle driver license in good standing and must be eligible to operate a motor vehicle owned by OHSU or other agency; or demonstrate the ability to access transportation to meet the requirements of the position.

• BLS/CPR certification within 6 weeks of hire.

Job Related KnowledgeSkills and Abilities(Competencies):

• Experience in behavioral health counseling and brief short-term therapy strategies and case management is required.
• Demonstrated commitment to valuing diversity equity and inclusion in the clinic and learning environment.
• Ability to contribute to the success of the organization through support of and seeking out diversified ideas and perspectives.
• Ability to utilize assessment information and collateral information to conceptualize patient psychopathology.
• Skill and expertise in conducting group and individual psycho-educational classes and brief short-term therapy strategies that will help strengthen the patients overall physical and mental health. Incorporation of self-management home-based practice in care planning.
• Skill in efficiently organizing time so that unscheduled same day services are routinely available to care team members.
• The ability to exercise sound judgment in appraising situations and making decisions regarding complex physical and behavioral health treatment issues in consultation with the primary care teams.
• Skill in developing effective working relationships with peers supervisors and professionals in related disciplines.
• Ability to manage complex personal interactions.
• Demonstrated ability to act with minimal supervision on personal initiative using sound clinical judgment.
• Strong written and verbal communication skills.

• Training in Integrated Behavioral Health
• Health care experience
• Experience and/or interest in Collaborative Care.
• Experience in a Primary Care Ambulatory Clinic setting.
• Experience with program development and evaluation.
• 3 years experience in similar position
• Language Knowledge: Spanish Vietnamese Mandarin Cantonese Russian Arabic Korean
• Licensed Clinical Social Worker (LCSW)
• Knowledge of the principles and practices of behavioral health consultation including assessment diagnosis treatment planning cognitive-behavioral counseling strategies and their application to population-based care for preventive and chronic care issues.
• Working knowledge of evidence-based psychosocial treatments and brief behavioral interventions for common mental health disorders when appropriate (e.g. motivational interviewing problem-solving treatment behavioral activation).
• Comprehensive understanding of the interrelationship between medical and psychological systems and their impact on health.
• Experience in documenting clinical activities in a comprehensive clear concise fashion on a same day basis. Basic knowledge of psychopharmacology for common mental health disorders

Hours: Variable. Five 8-hour shifts Monday-Friday with possibility of evening or weekend hours asneeded for program needs.

The work is performed in a medical setting. The position involves interactions with people who have awide variety of physical and behavioral health problems. Some travel may be required.