Function:
The Behavioral Health Care Manager is the hub of the Collaborative Care Model (CoCM) team for children and adolescents referred by pediatric and family primary care partners. This role manages a registry-based caseload, tracks symptoms over time, coordinates psychiatric case review, and keeps the referring provider informed through closed-loop communication.
Organizational duties & responsibilities:
The primary responsibility of all staff is to ensure safety and well-being of all RE/ Re-group clients.
Supports the mission, vision, and values of RE and Re-group. Facilitates and adheres to the agency and licensure code of ethics, policies and procedures.
Supports all functions that attain and maintain accreditation and compliance with regulatory agencies.
Supports and facilitates positive interaction with clients, staff, families, and community partners by exhibiting both in office and in the public when carrying out job duties: individual maturity, respect for others, a team-centered approach, maintenance of confidential information, and an awareness and sensitivity to cultural and other differences in others.
Exhibits effective communication skills, including proper use of agency communication systems.
Participates in appropriate professional development programs to attain and maintain competency.
Effectively manages financial and physical resources to achieve the mission of RE and Re-group.
Reports incidents of abuse or potential abuse involving clients to the appropriate authorities and RE/ Re-group.
Essential duties and Responsibilities:
Receive and triage referrals from pediatricians, family primary care providers, FQHCs, RHCs, hospitals, EMS, schools, DCBS, and community partners by acuity and need.
Enroll children and families in CoCM workflows and maintain a registry of active patients, including screening scores, follow-up dates, and care plan status.
Administer and track standardized measures such as PHQ-A, GAD-7, ASQ or C-SSRS, and CRAFFT, and flag patients who are not improving.
Prepare and lead weekly systematic case review with the psychiatric consultant; relay treatment recommendations to the primary care provider.
Complete outreach within 24 to 72 hours after crisis, EmPATH, ED, EMS, or hospital discharge events, with follow-up at 7 and 30 days and longer when indicated.
Provide brief, evidence-based interventions and care coordination by telehealth, phone, and in person.
Arrange warm handoffs to outpatient therapy, medication management, SUD services, peer/family support, and community resources.
Send closed-loop updates to referring providers consistent with consent, HIPAA, and 42 CFR Part 2.
Re-engage families after missed appointments and address barriers such as transportation, technology access, and caregiver strain.
Document all CoCM time and contacts accurately in the EHR to support billing and grant reporting.
Support partner onboarding and training on referral workflows and CoCM roles.
Collect and submit data for monthly DPH reports and participate in CQI meetings.
Working conditions/environment:
Shift is generally Monday – Friday, but hours will vary based on the needs of the client(s).
Holidays, weekends, and extra hours may be required.
Intense, unpredictable population with the possibility of verbal and physical aggression.
Fast-paced environment with a need for quick decisions to deal with any crisis that may arise.
Traveling throughout the week to meet with clients, families, and/or community partners in home and/or school settings, as well as out-of-town meetings.
Primary work setting is within the assigned program and could be in community settings, including the client's home and school.
Maintains a positive, professional attitude contributing to a supportive work environment.
minimum job requirements:
Education:
Master's degree in a behavioral health field, or a Kentucky license or associate license (CSW, LPCA, MFTA, or RN).
Experience:
Experience in community based program, 2…