Nurse Care Coordinator

Overview

Becoming part of the Sweetser family means you can make a difference in the lives of Maine children, adults, and families every day. As a nationally recognized and accredited leader, we offer competitive salaries, a wide range of benefits and the opportunity to join a passionate team of more than 700 employees.

Job Code: 13085

Location:

Saco 04072
Department:
Behavioral Health Home
Full Time/Permanent Status:
Full Time

The Nurse Care Coordinator shall provide regional primary care consultation, psychiatric care consultation; work with the Behavioral Health Home Organization (BHHO) & Certified Community Behavioral Health Clinic (CCBHC) team, Child Assertive Community Treatment Team, Private Non-Medical Institute, and other members to facilitate care across the healthcare continuum.

$5,000 sign‑on Bonus!
Pay starts at $33/hour!

• Provide education and support around medications to the Interdisciplinary Team (IDT), members, and families.
• Provide medical education about chronic disease management to IDT members, families and groups.
• Liaison to Health Home, ACT Teams, CCBHC Practices/Primary Care Physicians.
• Collaborate with the IDT on member plan of care.
• Review Health Questionnaire and provide recommendations to IDT and/or members and families for medically compromised participants.
• Assist, and/or make recommendations regarding skill development in activities of daily living, including hygiene, nutrition, exercise, general health maintenance/improvement.
• Support implementation of grant funded projects such as In-Shape, CTI, and other health and wellness pay for performance initiatives in geographical area where program is offered.
• Support Behavioral Health Home team, CCBHC and Child ACT in achieving organizational and state required outcomes, including but not limited to A1C testing, tobacco screening and annual health screenings.
• Be proficient in EHR, HIN, and VMS systems in order to extract clinical data and alerts in order to support level of care.
• Consult with IDT and members as indicated regarding discharge planning recommendations and follow up.
• Monitor emergency department usage and coordinate with IDT and other providers to promote least restrictive level of care.
• Medication reconciliation through EHR from external providers (i.e. PCP, Specialists, etc.) when appropriate.
• Provide medication and medical education to Interdisciplinary Team (IDT), members, and families.
• Complete pharmacy enrollments, medical equipment orders, and other supports/services to support recovery goals.
• Provide CRMA Training and Supervision as needed.
• Schedules will vary according to program needs (as applicable):
• On-call responsibilities as assigned

• Provide excellent customer service.
• Active participation in supervision of student interns, as appropriate and needed.
• Ensure the confidentiality of all patient information and release of information from area(s) of responsibility.
• Ability to support and recognize the important role volunteers play. Sweetser employees work with, support, collaborate with volunteers, and promote opportunities for volunteer engagement.
• Exercise judgment consistent with clinically accepted standards of community practice in determining whether to transport a particular patient(s).
• Maintain adequate personal vehicle insurance coverage, a valid state driver’s license, a vehicle that is in good repair and a good driving record as per organization policy.
• Active participation in required supervision as determined with Program Manager according to licensure level.
• Timely and accurate provision of administrative paperwork according to the time frame established by the organization’s policies.
• Active participation in administrative meetings, including program meetings and general staff meetings.
• Understand and comply with all Sweetser policies and procedures as identified in the Human Resources Policy Manual.
• Maintain administrative responsibility (charting/documentation, etc.)
• Active participation in in-service training and continuing education programs.
• Active participation in providing community education to staff, community groups, etc., as…