SHS-POP HEALTH BEHAVIORAL HEALTH CARE MANAGER

General Purpose of Job:

As part of the Department of Population Health, the Behavioral Health Care Manager (BHCM) will be centrally supporting five primary care practices within the University of Michigan Health-Sparrow (UM Health-Sparrow) system. Building on a strong foundation of Behaviorial Health Integration (BHI), the team will be launching Collaborative Care(CoCM) as a new program, assisting both patients and providers in an integrated care model.

Common Duties and Responsibilities:

As a member of the larger ambulatory behavioral health team, this BHCM will play a vital role specific to rolling out CoCM to improve access for patients with depression, anxiety and other mental health diagnoses. The goal of this program is to integrate behavioral health services into primary care offices to offer assistance that supports the wellbeing of both the patient's physical and mental health.

Specifically, CoCM focuses on a defined patient population who are tracked in a registry to monitor treatment progression. The treatment plan focuses on measurement-based treatment to target, to ensure the patient's goals and clinical outcomes are met. The CoCM team includes the primary care provider, the BHCM, and a psychiatric consultant to meet regularly for a caseload review where there are opportunities to adjust the plan of care for patients. The BHCM is the heart of the CoCM, facilitating communication amongst all team members and acting as the lead point of contact for the patients enrolled.

This position is a great opportunity to be a valuable part of a multidisciplinary team within the primary care practices.

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis. Team members may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.

• Supports the mental and physical healthcare of patients on an assigned patient caseload. While coordinating care with the patient's medical provider and, when appropriate, other mental health providers.
• Screens and assesses patients for common mental health and substance abuse disorders. Facilitate patient engagement and follow-up care.
• Provides patient education about common mental health and substance abuse disorders and the available treatment options.
• Systematically track treatment responses and monitor patients (in person or by telephone) for changes in clinical symptoms and treatment side effects or complications.
• Supports psychotropic medication management as prescribed by medical providers, focusing on treatment adherence monitoring, side effects, and effectiveness of treatment.
• Provides brief behavioral interventions using evidence-based techniques such as behavioral activation, problem-solving treatment, motivational interviewing, or other treatments as appropriate.
• Provides or facilitates in-clinic or outside referrals to evidence-based psychosocial treatments (e.g. problem-solving treatment or behavioral activation) as clinically indicated.
• Participates in regularly scheduled (usually weekly) caseload consultation with the psychiatric consultant and communicates resulting treatment recommendations to the patient's medical provider. Consultations will focus on patients new to the caseload and those who are not improving as expected under the current treatment plan. Case reviews may be conducted by telephone, video, or in person.
• Tracks patient follow-up and clinical outcomes using a registry. Documents in-person and telephone encounters in the registry and uses the system to identify and re-engage patients.
• Documents patient progress and treatment recommendations in Epic and other required systems so as to be shared with medical providers, the psychiatric consultants, and other treating providers.
• Facilitates treatment plan changes for patients who are not improving as expected in consultation with the medical provider and the psychiatric consultant and who may need more intensive or more specialized mental health care.
• Facilitates referrals for clinically indicated services outside of the organization (e.g., social services such as housing assistance, vocational rehabilitation, mental health specialty care, substance abuse treatment).
• Develops and completes relapse prevention self-management plan with patients who have achieved
• their treatment goals and are soon to be discharged from the caseload.