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3 weeks ago
- Identifies participants in need of clinical services based on acuity/need across all centers.
- Develops and accepts internal referrals from CEI providers and/or IDT for clinical and consultation services based on assessed need across all centers.
- Conducts diagnostic assessments to make recommendations to IDT, and develops a treatment plan of care for behavioral health services.
- Provides crisis intervention services and monitors participants during psychiatric hospitalizations, consulting with hospital staff during discharge planning.
- Conducts individual and group psychotherapy for those with behavioral health treatment needs. Determines level and frequency of services and the discharge plan to center social work team for continued support as needed.
- Makes appropriate referrals to outside behavioral health vendors (e.g. Intensive Outpatient Program, Substance Use Treatment, etc.) and monitors use of services, consulting with agency on participant progress and discharge planning.
- Manages assigned panel of participants with behavioral health needs. Maintains documentation of participant behavior, interventions, conditions and outcomes that affect behavioral health and prepares reports in the electronic health record to care/treatment plans and related documents.
- Facilitates and conducts meetings with participants, family members and caregivers to provide advice on how to support behavioral health interventions and care plan objectives.
- May interview participant’s family members and caregivers to assess home environment, individual functioning, family dynamics and contributors to behavioral health concerns.
- Collaborates with the primary care team and CEI Social Workers to provide ongoing behavioral health support and interventions to participants.
- Participates on interdisciplinary team (IDT) meetings once a month to assist with the development and implementation of a comprehensive, integrated plan of care, and monitors progress toward objectives by evaluating behavior and communicating participant changes to team members.
- Leads and facilitates behavioral health psychosocial rounds at centers for case review, identify interventions and or staff development for similar cases.
- Develops and maintains working relationships with other community resources such as Department of Social Services, psychiatric facilities, hospitals, social agencies, and other behavioral health resources and may participate in hospital and/or SNF discharge planning as it relates to behavioral health needs.
- Trains and supports staff to increase competencies in serving participants with behavioral health needs.
- Trains and supports caregivers to increase competencies in serving their loved one with behavioral health needs.
- Occasionally assess potential participants interested in CEI with significant behavioral or mental health backgrounds for appropriateness to PACE based on standardized health and safety criteria. Make recommendations for approval or denial of enrollment accordingly.
- Makes visits to various locations to meet with participants and/or service providers, including but not limited to, participant’s homes, hospitals and skilled nursing facilities.
- Maintains the confidentiality of all company procedures, results and information about participants, clients or families in conformance with HIPAA principles.
- Performs related duties as assigned.
- Master’s degree in Social Work, Marriage and Family Therapy, or Professional Clinical Counselor; or Doctorate in Clinical Psychologist; (LCSW, LMFT, LPCC, or PhD license required);
- 2 years’ experience providing diagnostic assessment, treatment planning, crisis intervention and psychotherapy required.
- One year experience working with a frail and/or elderly population with Health Psychology model preferred.
- Demonstrated ability to work in a multicultural and multidisciplinary team environment.
- Ability to work independently.
- Excellent oral and verbal communication and meeting facilitation skills.
- Experience working with severe mental illness and substance abuse is desirable.
- Bilingual ability highly desirable (Spanish, Korean, Cantonese, and/or Mandarin).
- Valid California driver's license, acceptable driving record and insurance with access to reliable transportation.
Center for Elders’ Independence is a PACE (Program of All- Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities. Unlike other healthcare plans, CEI is not a "fee-for-service" plan. It is a “capitation” healthcare plan. CEI is paid a set amount for each person enrolled in our program, whether or not that individual seeks care. We are a growing company that offers stability and continues to thrive.
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