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Why This Role is Important to Us:

The Community Behavioral Health Clinician ensures that a CCA enrollees receive the highest quality behavioral health care within the context of a member centric individualized plan of care. The Community BHC has the opportunity to use evidence, clinical skills, education, and training to influence the clinical outcomes of CCA's members by impacting acute psychiatric hospitalizations, optimal treatment for severe, persistent mental illness, closing of quality gaps, and optimizing substance use services.

As an integral part of an Interprofessional Care Team and based on the fluctuating needs of a defined panel of members, the Community Behavioral Health Clinician will provide assessments, both in person and/or through Virtual visits at regularly scheduled intervals and on an emergent basis to ensure that members' Plan of Care is fully comprehensive and addresses significant medical, behavioral, and social needs.

The Community Behavioral Health Clinician will identify gaps in member's care and unmet needs and provide recommendation and interventions. The Community BH will coordinate with the Care Partner along with the PCP (Primary Care Provider), Community BH providers, social supports and CCA's interprofessional clinical care team to identify areas of opportunity, as well as defined resources, and will work in coordination with the team to implement the care plan.

The Community Behavioral Health Clinician will engage in direct delivery of Behavioral Health Care for identified members who are in need of bridge therapy while awaiting a referral to a network Behavioral Health provider. There is also opportunity for a Community BH Clinician to hold a defined panel of members with Severe Persistent Mental Illness and will provide long term support for those with the most significant behavioral health needs.

The Community BHC will have an ability to engage with members with identified or rising risk of Substance Use Disorder, and work with the interprofessional care team to ensure that members are appropriately referred for addiction treatment.

The Community BHC is a member of the care team that provides behavioral health assessments, diagnosis, psychiatric hospital/crisis discharge follow-up as well as consultation, education, and support to members and other team clinicians regarding behavioral health/substance use treatment and management.

The Community BHC reports to a BH Manager.

The Community BHC also provides input to members' Care Partner on key care management/care coordination decisions, including the adjustment of the member-centered care plan and identification of the need for services and/or equipment.

Provide clinical care to members via telehealth technologies (video, chat, etc.) for a clinically appropriate clinical care and care management services.

Supervision Exercised : No

What You'll Be Doing:

• Performs episodic urgent visits to ensure that members are given timely and appropriate behavioral health support and care to avoid emergency room or hospitalization.

• Facilitates and/or delivers preventative care and behavioral health services to members according the guidelines deemed appropriate by CCA Clinical Leadership.

• Identifies and initiates a plan to resolve areas of opportunity

• Meets BH HEDIS measures by following strict follow-up and documentation guidelines

• Provides scheduled visits to conduct BH assessment and follow up visits for the management of co-morbid BH complexity and substance use concerns

• Liaises with CCA Care Partner and community-based PCPs/ Specialists and community BH providers as needed

• Documents all activities and results using both the Electronic Medical Record and Care Management Platform, in an effective manner while strictly adhering to CCA policies and procedures

• Works closely with Telephonic Care Partner to ensure that Care Plan is accurate, up to date and reflect members BH needs

• Provides behavioral health support and consultation to clinical team disciplines and other teams as needed

• Provides members with psycho-social, mental health, substance use and cognitive assessments as needed

• Performs crisis and risk assessments, interventions and develops a crisis plan

• Collaborates with community providers who are supporting members mental health and psycho-social needs

• Performs short-term bridge therapy to members

• Maintains a connection to community services and on-going care coordination with community providers to ensure that they member receives the highest quality care

• After assessing members, provides accurate BH diagnosis

• Determines member's behavioral health needs and potential solutions through case conferences and in person assessments.

• Performs crisis assessment and referrals to CSU and inpatient facilities as needed.

• Has training and knowledge of the behavioral health continuum of care, including levels of care from inpatient to outpatient.

• Can identify substance use needs and make appropriate referrals for treatment and follow up.

Working Conditions :

• Predominantly in the community. Must be willing and able to travel to member's homes in addition to working in an office environment occasionally.

• Must be willing and able to come to the CCA office to attend various meetings.

• Reliable transportation required.

• Valid driver's license with no restrictions. Ability to be active and mobile.

What We're Looking For:

Education Required:

• Minimum Education Required - Master's Degree in Social Work

• Clinical Licensure, per state requirements, in the field of Social Work

• Must be eligible for Licensure Reciprocity to practice in MA or currently have MA Clinical Licensure as stated above

Licensing Required:

• Clinical Licensure, per state requirements, in the field of Social Work:LCSW, LICSW, LMHC, PsyD or PhD.

Experience Required:

Minimum Years' Experience Required - 2+ years meaningful clinical experience with adults (including clinical internship experience)

• Past experience caring for adult patients/members with complex medical, behavioral health, and social needs in a community setting.

• Crisis and substance use experience

• Ability to conduct and document a Mental Health, SUD, Crisis and other Assessments

• Ability to utilize an Electronic Medical Record

Experience Desired:

• Case management and/or experience in managed care desired.

Knowledge, Skills & Abilities Required:

• Ability to take initiative

• Ability to work independently

• Ability to participate in a multi -- disciplinary team environment

• Strong organizational skills

• Knowledge of Microsoft products

• Proficiency in the use of technology

• Willing to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services.

Language(s) Required:

• English

Language(s) Desired:

• Spanish

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.