Clinical Nurse-Behavioral Health Care Facilitator duties shall include but not limited to the following:
a) Proactively identifies and evaluates patients and targeted populations for mental health case management, care coordination and facilitation, and conditions monitoring from a variety of sources such as Behavioral Health or primary care provider referrals, discharge planning, Medical Evaluation Board (MEB) process, facility staff and patient self-referral. Conducts systematic, on-going, thorough assessment of patients emotional, psychological, social and medical status, prescribed medications, behavioral health referrals/treatments, and other pertinent information via direct patient or telephonic contact, or other relevant sources such as professional and non-professional caregivers and the medical records.
b) Develops, executes and provides ongoing monitoring of appropriate patient-specific plan of care including short and long term goals, objectives and actions. Coordinates and collaborates on the care plan along with the patient, family/caregiver, and healthcare team.
c) Identifies, develops and executes appropriate targeted population-based mental health disease management activities such as, but not limited to individual and/or group patient contacts and training programs.
d) Serves as an advocate for and ensures appropriate education is provided to the patient or targeted populations for the purpose of promoting adherence to treatment plans, self-care actions, and education programs. Ensures activities match the level of the patients clinical risk, readiness to change and health literacy.
e) Identifies, collects, monitors, interprets and evaluates measureable outcome data within established time frames according to local/AF/DoD requirements. Submits reports as required per local/AF/DoD policy and guidance.
f) Educates/trains the healthcare team and facility staff on policies and procedures for utilization and implementation of guidelines, protocols and other behavioral health and mental health disease management activities.
g) Coordinates and participates in interdisciplinary team meetings, designated facility meetings, and Care Coordination meetings. Shares knowledge and experiences gained from own clinical nursing practice and education relevant to mental health nursing and case management. Participates in local, AF, DoD and national teleconferences as required and relative to the program operations and reporting requirements.
h) Participates in the orientation, education and training of other staff. May serve on committees, work groups, and task forces at the facility.
i) Must maintain a level of productivity and quality consistent with: complexity of the assignment; facility policies and guidelines; established principles, ethics and standards.
HEALTHeCAREERS Network - 24 months ago
Systems Assessment & Research, Inc. (SAR Corp) is a comprehensive health care, management and research services firm built on more than...