Behavioral Health Nurse

SUMMARY:

The Behavioral Health Nurse plays a critical role in supporting integrated, whole-person care within the Certified Community Behavioral Health Clinic (CCBHC). This position is responsible for providing primary care screening and monitoring services for individuals receiving behavioral health services, with a particular focus on clients with complex behavioral and physical health needs. The Behavioral Health Nurse receives clinical guidance related to physical health screening and nursing practice from the Chief Medical Officer and administrative oversight from Behavioral Health leadership

The Behavioral Health Nurse works collaboratively with clinical teams - especially the Community Support Team - and serves as a key liaison between behavioral health services and clients' medical providers (either internally through our Federally Qualified Health Center or external providers). This role does not provide ongoing primary care treatment, but ensures timely screening, monitoring, coordination, and follow-up in accordance with CCBHC requirements.

Definitions:

Consultation: refers to nursing-level clinical communication and collaboration focused on assessment findings, care coordination, patient education, and escalation of clinical concerns to licensed providers. This role does not include diagnosis, prescribing, or independent medical decision-making.

Medication Monitoring: includes reviewing documented medication lists, assessing for adherence, side effects, or adverse reactions, providing patient education, and communicating identified concerns to the prescribing provider in accordance with established protocols.

The BH RN does not diagnose, prescribe, alter treatment plans, or provide medical orders. All medical decision-making remains with licensed prescribing providers.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Care Coordination & System Navigation

* Serve as a key connector between behavioral health services, primary care, specialty medical providers, and community resources.

* Review clinical assessments and screening information to identify unmet physical health needs and unmanaged chronic health conditions and facilitate timely connection to appropriate medical providers.

* Identify barriers to accessing medical, dental, and specialty care, and connect clients with needed services.

* Assist clients with transportation resources, scheduling, and navigation of health systems.

* Engage and link clients to peer support and community-based services.

* Demonstrates proficiency in the use of electronic medical record systems to document nursing assessments, interventions, medication monitoring activities, and care coordination, and to review relevant clinical information in support of integrated, team-based care.

* Participates in quality improvement activities related to physical health screening, follow-up, and continuity of care for behavioral health clients

Primary Care Screening & Monitoring

* Complete Health Risk Assessments (HRAs) and other required primary care screening and monitoring activities for behavioral health clients in accordance with CCBHC requirements and organizational protocols.

* Collect and document vital signs and other physical health screenings (e.g., blood pressure, BMI, weight, etc.) as clinically indicated.

* Monitor and support laboratory testing and physical health follow-up for clients prescribed psychotropic medications or with identified chronic health conditions.

* Review recent hospital or emergency department discharges, ensuring continuity of care.

* All nursing activities are performed in accordance with agency-approved protocols, standing orders, and policies consistent with the Illinois Nurse Practice Act.

Consultation & Team-Based Clinical Support

* Provide consultation to behavioral health providers regarding physical health considerations impacting behavioral health treatment.

* Join the Community Support Team (CST) as a nursing resource and provide consultation and support for clients with high physical health needs.

* Act as a clinical bridge between CST staff and clients' primary care and specialty medical providers to support coordination, communication, and continuity of care.

* Support coordination related to chronic disease management, medication monitoring, and preventive care.

* Identifies changes in client condition or emergent medical concerns and follows established escalation procedures, including timely notification of licensed providers and emergency services as appropriate.

Medication & Nursing Support

* Provide medication-related education and training to clients and families, including purpose of medications, expected benefits, common side effects, and when to seek medical attention.

* Monitor medication adherence and tolerability, observe for potential side effects or adverse reactions, and communicate concerns to prescribing providers and the care team (with appropriate release of information).

* Ensure active medication lists are current by collecting medication…