Responsibilities Essential Job Functions: Integrated Medical Support • Obtain and accurately document vital signs, height, weight, BMI, and other physical health indicators. • Assist in identifying unmet physical healthcare needs. • Perform CLIA-waived testing and specimen collection as authorized. • Perform venipuncture and laboratory collection consistent with certification and organizational policy. • Monitor completion of ordered laboratory studies. • Report abnormal findings promptly to licensed nursing staff or medical providers. • Prepare patients for psychiatric and medical appointments. • Maintain clinical equipment. Care Coordination Coordinate physical healthcare services between behavioral health, primary care, specialty care, hospitals, emergency departments, pharmacies, and community providers. • Assist patients in scheduling medical appointments. • Obtain hospital discharge information. • Coordinate post-hospital follow-up appointments. • Assist patients with specialty referrals. • Monitor completion of recommended preventive healthcare services. • Assist patients in reducing barriers to healthcare access. • Participate in care transitions following hospitalization, crisis stabilization, detoxification, residential treatment, or incarceration. • Document all care coordination activities in the electronic health record. Medication Support Under supervision of licensed clinical staff: • Complete medication reconciliation at admission, annual update, and transition of care. • Maintain current medication lists. • Monitor patients for medication adherence. • Observe and report potential medication side effects. • Reinforce medication education provided by licensed practitioners. • Coordinate medication refill requests according to organizational procedures. Population Health Management Assist by monitoring patients identified as high utilizers or medically vulnerable. Responsibilities include: • Tracking preventive health screenings. • Monitoring metabolic screening for individuals prescribed antipsychotic medications. • Monitoring diabetes care indicators. • Monitoring hypertension. • Monitoring obesity and BMI. • Monitoring tobacco cessation interventions. • Monitoring immunization status. • Assisting with outreach for patients overdue for appointments. • Supporting CCBHC quality measures and clinical outcomes. Health Education Provide education consistent with provider treatment recommendations regarding: • Medication adherence • Diabetes management • Hypertension management • Nutrition • Physical activity • Tobacco cessation • Sleep hygiene • Preventive healthcare • Wellness recovery planning • Self-management of chronic disease Documentation Complete documentation according to: • Alabama Medicaid Administrative Code Chapter 105 • CCBHC Certification Criteria • Joint Commission standards • Organizational policies Documentation shall: • Be completed within 24 hours of provision of service • Accurately reflect services delivered. • Support medical necessity. • Support billing requirements. • Demonstrate care coordination activities. • Reflect person-centered care. • Maintain confidentiality. Interdisciplinary Team Participation • Participate in interdisciplinary treatment team meetings. • Collaborate with psychiatrists, nurses, therapists, case managers, peers, primary care providers, and community partners. • Assist with integrated treatment planning. • Communicate significant changes in physical or behavioral health. • Participate in case reviews for high-risk patients. Quality Improvement • Participate in Performance Improvement activities. • Participate in CCBHC quality initiatives. • Assist with collection of quality indicator data. • Support population health reporting. • Participate in audit readiness activities. • Assist with compliance monitoring activities. Professional Responsibilities • Maintain CMA certification. • Maintain CPR certification. • Complete required continuing education. • Attend required staff meetings and trainings. • Maintain competency in trauma-informed care and cultural responsiveness. • Follow organizational policies and procedures. • Demonstrate ethical and professional conduct. • Perform other duties as assigned. Ability to: • Work effectively within an interdisciplinary team. • Communicate effectively with patients and providers. • Prioritize multiple tasks. • Maintain accurate documentation. • Demonstrate compassion and professionalism. • Utilize recovery-oriented practices. Physical Requirements • Frequent standing, walking, sitting, bending, reaching, and keyboard use. • Frequent travel within the community. • Ability to lift up to 30 pounds. • Ability to perform venipuncture and other clinical procedures. • Ability to respond appropriately during behavioral health crises. • Ability to operate standard clinical equipment. • Ability to work in outpatient clinics, community settings, hospitals, shelters, and patients' homes when assigned. Performance Standards Performance will be evaluated based upon: • Compliance with Alabama Medicaid Chapter 105. • Compliance with CCBHC Certification Criteria. • Timeliness of documentation. • Quality of care coordination. • Patient satisfaction. • Accuracy of medical documentation. • Participation in interdisciplinary care. • Compliance with quality improvement initiatives. • Adherence to organizational policies and ethical standards. Qualifications Minimum Qualifications: • Current Certified Medical Assistant (CMA) certification from an accredited certifying body. • Current CPR certification preferred or to be obtained within 1 month • Valid Alabama driver’s license with acceptable driving record • Ability to travel throughout the service area. • One year of medical office, primary care, behavioral health, or integrated healthcare experience preferred Within six (6) months of employment, the employee will demonstrate competency in: • Serious Mental Illness (SMI) • Substance Use Disorders (SUD) • Co-occurring Disorders • Integrated Behavioral Health • Trauma-Informed Care • Recovery-Oriented Care • Motivational Interviewing • Infection Prevention • Medical Terminology • Psychotropic Medications • Medication Side Effect Recognition • Suicide Prevention • Crisis Intervention • Cultural and Linguistic Competency • HIPAA • Alabama Medicaid Chapter 105 requirements • CCBHC Certification Criteria