Concert Health

Bilingual

• Provides care to patients, based on needs of assigned Care Pod, customizing treatment plan to individual patient needs
• Supports and closely coordinates behavioral health care with the patient’s primary care provider and (when appropriate) other service providers
• Screens patients for common behavioral health and substance use disorders using PHQ9, GAD7, Columbia Suicide Risk Assessment, or other tools as required
• Monitors patients for changes in clinical symptoms and treatment side effects/complications, with a goal of reduction in symptoms
• Supports psychotropic medication management prescribed by PCPs, focusing on treatment adherence, side effects and other complications, and treatment effectiveness
• Tracks patient follow-up and clinical outcomes using a registry, records encounters in the registry and uses the system to identify and re-engage patients
• Plans specific mutual self-management goals, objectives, and interventions with action-oriented patients
• Facilitates care plan changes for patients who are not improving, including changes in medications or psychosocial treatments or appropriate referrals for additional services
• Documents patient progress and treatment recommendations in Salesforce and the electronic health record so they can be easily shared with primary care providers, the psychiatric consultant, and other treating providers
• Completes relapse prevention plan with patients who are in remission
• Educates patients about behavioral health/substance use disorders and treatment options
• Establishes mutually agreeable care management plan with the care team and patient/family
• Participates in regularly scheduled caseload consultations with psychiatric consultants
• Participates in regularly scheduled supervision sessions with clinical supervisor
• Identifies social determinant barriers and works alongside the Care Navigation Partner to assist in providing access to the correct level of internal or external care

Bilingual Clinician, LMSW or LCSW – Behavioral Health, Pediatrics