Department: Care Coordination
Manager’s Title: Recovery Care Coordination Manager
FLSA Status: Non-exempt
Job Summary: The Recovery Nurse Care Manager (RN) is a licensed staff member responsible for coordinating screening and providing the intervention of patients with identified complex chronic care needs, including substance use recovery. Functions in the capacity of a connector between the patient’s needs and the resources provided by PCC’s Austin Recovery Connections (ARC) program. Supports whole health outcomes and communicates progress to those in the healthcare organization as well as ensuring the patients receive the best possible care.
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Essential Duties and Responsibilities:
- PCC’s Austin Recovery Connections (ARC) program supports patients with substance use disorders, including opiate use disorder and alcohol use disorder. Patients may participate in medication assisted recovery (MAR), behavioral health counseling, and behavioral health group visits. The Recovery Nurse Care Manager (RN) supports this clinic by increasing patients’ self-management skills, reducing patient barriers to participation in CDC programs, providing administrative support, as well as supporting patient referrals to higher levels of care.
- The Recovery Nurse Care Manager (RN) shows dedication to treating substance use disorder in an interdisciplinary, outpatient setting. Provides therapeutic support to patients in clinic, in groups, and over the phone. Advocates for patients to insurance payors, inpatient and outpatient treatment facilities, and social service agencies.
- The Recovery Nurse Care Manager (RN) provides consultation and academic support to residents and attending physicians within the ARC, Pregnant and Postpartum Women (PPW) and Hepatitis C Program in the areas of bio psycho social care coordination that may affect overall health outcomes including social determinants of health, substance use and mental health concerns. Closely collaborates with interdisciplinary team to provide coordinated care for all Chemical Dependency Center patients.
- Provide comprehensive consultation regarding disease management assessment and mental/behavioral health treatment options to new and established patients to the PCC Chemical Dependency Center.
- Assess patients’ and/or families’ bio-psycho-social situations that include: development issues, family dynamics and stressors, and DSM V diagnoses.
- Maintain patient registry completing outreach as clinically necessary based on patient social, medical, and behavioral health needs.
- Communicate and coordinate with payers to ensure coverage of essential medications
- Administer injections in-clinic according to provider orders. Conduct prior authorizations and order tracking as required for patients on recurring long-acting injectable medications, and/or Hepatitis C treatment.
- Identify and follow-up on all referrals made to assure continuity of care and patient/family needs are met.
- Complete disease specific education as necessary with patient and patient family.
- Communicate with providers and care team regarding patient progress and care needs.
- Participate fully in relevant quality assurance and performance improvement measures.
- Complete home visits, or visits to skilled nursing facility, or hospital as needed and determined by the care team.
- Participate case consultation as part of the interdisciplinary care team
- Maintain patient care hours per week at designated site as determined by Recovery Care Coordination Manager and Chief Public Health Officer.
- Performs other duties as assigned.
- Following PCC workflows, nurse-prepared CM may conduct nurse-driven visits.
- Nurse-prepared CM may support group medical visits, including but not limited to VeggieRx.
- Nurse-prepared CM may complete additional assessment, clinical, or administrative support for sub-populations and/or funder requests, according to manager assignment as appropriate to their degree scope