Community Based Care Manager

PHMC is proud to be a leader in public health. PHMC requires all employees to be vaccinated by first day of employment. We will offer the vaccination at no cost, via our Health Centers.

Community-Based Care Manager (CBCM) sought to work as part of the opioid Use Disorder  (OUD) Medical Home, also referred  to as Center  of Excellence (COE). This COE has been created  by the Commonwealth  of Pennsylvania  to help address systematic  factors that contribute  to problematic  use of opioids in the community. Duties will include working with a care management  team  to accept referrals of individuals with OUD from local emergency departments, state and county corrections facilities, inpatient  and outpatient residential substance  use providers,  and from primary care providers and helping these individuals connect to, and remain supported by, a variety of community resources. The CBCM will work to motivate and encourage  individuals with OUD to stay engaged in both physical health and mental  health treatment. The CBCM will be responsible for connecting with new individuals with OUD via outreach  to address  their care needs, as well as ensure continued engagement of referred  individuals  with OUD to assist with ongoing care coordination. The CBCM reports directly to the Center of Excellence supervisor. This is a full-time position that will require  frequent, local travel.

*Responsibilities:

• Outreach within target communities and key institutions including, hospitals, primary care settings, homeless shelters, and prisons to reach adults struggling with opioid use disorder, and connect them to assessments with the COE
• Providing ongoing support to assigned individuals with OUD and additional needs, to help them access resources that will assist in improving their treatment and daily life This includes monitoring at a regular, assigned frequency to assess resource connection and helpfulness, and troubleshooting  problems that arise.
• Consultation with primary care and treatment providers to ensure patients struggling  with OUD are fully engaged in care, provide support for treatment planning, and assist in the implementation of evidence -based assessments and  care connection
• Productively work to help the COE meet program expectations for outreach and care
• Participate in a learning network that will include increasing awareness of OUD-related resources and needs; complex case-based learning; and ongoing supervision will occur with the COE
• Partner with Quality Management, supervisor, and clinical teams to track and internally report key metrics at an individual and aggregate
• Maintain appropriate records of activities, patients, fidelity, and outcomes

Coordination of Care- Facilitate recovery by helping individuals find stable housing and employment and help them to re-establish family/community relationships. Provide feedback to and coordinate care of patients with health center primary care staff.  Identify, refer, and advocate for patients needing specialty behavioral  health service, and other services as needed.

*Skills:

• Excellent interpersonal skills; comfort working with diverse populations
• and in multidisciplinary teams;
• Ability to maintain client confidentiality; sensitivity to racial/ethnic and economic diversity;
• Microsoft Office and basic computing skills; ability to complete computer-generated

*Experience:

• Experience working as a member of an interdisciplinary team
• Comfort working with diverse populations (i.e. race, ethnicity, diagnoses, age ranges)
• Preference is placed on prospective employees who have demonstrated experience  in community outreach, working with vulnerable populations, including  but not limited to those with substance  use and/or mental health conditions, and previously incarcerated

*Education Requirement:

• Bachelors’ Degree in Social Work or related field from an accredited school, or Associates Degree in human Services or related field  from an accredited school plus minimum three years of related work experience, or equivalent experience.

Salary:  Based on education and experience.