The Family Behavioral Health System provides an integrated and flexible array of strengths-based therapeutic services and supports to families and children with complex therapeutic needs. Family Behavioral Health Services are delivered primarily in the client’s home or community and are designed to reinforce the strengths of the family to prevent the out-of-home placement of a child or prepare for the return home of a child from out-of-home care. Services focus on empowering the family to effectively use their strengths and abilities to address their needs and challenges with the primary goals of supporting them to become self-sufficient and to strengthen their relationships with community and natural supports that can sustain their long term success.
The Psychiatric Care Coordinator (PCC) provides direct assistance to the psychiatrist(s) and psychiatric ARNP(s) for Family Behavioral Health (FBH), and ensures all medical information is correctly entered into the FBH Electronic Health Record (EHR)/patient chart. He/she facilitates patient flow, completes telephonic triage for scheduling of psychiatric evaluations and medication monitoring, and follows up with all areas pertaining to prescriptions of psychotropic medications. This includes the study of changing formularies within multiple Managed Care Organizations (MCOs), gathering of detailed history of prior psychotropic medications prescribed, documenting dosage, frequency, effects and side effects, and entry of such into the EHR. Frequently the PCC will negotiate with the MCO (insurance) to receive authorization for needed prescriptions, which may not be included in basic formularies. This employee will also interact with the MCO Pharmacy Chief (or other applicable MCO authority) when problematic issues pertaining to prescription payment authorizations arise. When prescription payment authorization is denied, this employee completes the appeal process, unique for each MCO. Once ordered and payment is authorized, the prescription is faxed/called in to pharmacy or ordered through the online prescription service by the employee. As most FBH prescriptions are for behavioral health issues and are psychotropic medications, this can be a complex and time-consuming process. Those who assist our psychiatrists and ARNP’s also complete additional medical components of the Electronic Health Records/patient charts pertaining to demographics, current symptoms and behaviors, prior prescribed psychotropic medications, dosage and effectiveness/side effects. Weight and blood pressure are collected and documented at patient’s arrival.
Duties (completed prior to appointment when possible):
- Gather primary referral (to psychiatric care), behavioral symptoms and concerns from parent, CCS Clinician and others as appropriate. Gather pertinent information from patient and complete patient history, medication history (including dosage, frequency, side effects and effectiveness), and pertinent medical history. Ensure our questionnaires and medical appt forms are completed in advance of appointment. Document information in EHR/medical chart.
- Complete and document further assessment information in accordance with psychiatrist and psychiatric ARNP expectations.
- Update patient’s FBH chart, verify demographic information. Confirm no changes in insurance/MCO, address, phone, primary care and other physicians, etc.
- Update current medications, dosages, side effects and effectiveness. Document in EHR/medical chart for psychiatric providers and for use with MCO prescription formulary negotiation.
- Prepare any known needed permissions and releases for communicating with others involved in medical treatment of the child or youth, as appropriate. Provide to parent or caregiver for signature at time of first appointment.
- Provide psychiatrist or ARNP completed permission and release forms for parent or caregiver to sign during appointment.
- As directed by FBH psychiatric staff, coordinate with the child’s Primary Care Physician’s office (PCP) to ensure needed information is shared bi-laterally, per parent or caregiver permissions, and requests of FBH medical staff.
- Evaluate needs of emergent patients (those who must be seen with no scheduled appointment) as immediately as possible, working with parent, clinician and PCP to find an appointment time, and complete written information as completely as possible for psychiatric provider in advance of appointment.
- Maintain manageable schedule for psychiatric providers, ensuring patient flow is constant but not too tightly scheduled. It is important to ensure no more than one patient at a time with significant behavioral issues are in waiting areas at the same time. If siblings with significant behaviors will be present for appointments, plan ahead with Clinician for in-office support if needed.
Duties at time of appointments;
- Warmly greet and engage children and youth as well as parents and other caregivers as they arrive. Help to de-escalate anxious patients as well as those demonstrating overt behavioral issues. Be prepared to calmly re-direct and de-escalate, ensuring alternative activities are available to create distraction while maintaining a low key, quiet, non-stimulating environment.
- Take patient vitals at each appointment, and document completely and accurately in the EHR/patient chart.
- Be available/accessible to assist psychiatric provider “in the moment” if needed during child or youth appointments.
Duties pertaining to medications and prescriptions;
- Maintain current information regarding the varying current formularies per multiple Managed Care Organizations (MCOs),
- As needed, provide additional information, and negotiate with the MCO (insurance) to receive authorization for prescriptions ordered. Some prescriptions will not be included in basic formularies. When FBH psychiatric staff does not feel a substitution contained on the formulary list will be effective, and authorization cannot be secured it may be necessary to contact the MCO Pharmacy Chief (or other applicable MCO authority).
- When prescription payment authorization continues to be denied, this employee completes the appeal process, unique for each MCO.
- Once ordered and payment is authorized, the prescription is ordered through the online prescription service, or faxed/called in by the PCC
Duties following psychiatric appointments;
- Provide patients with written educational material and instructions pertaining to diagnosis, medication(s) prescribed, side effects. Ensure parent or caregiver clearly understands dosage, frequency, missed dosage instructions and reactions or side effects that constitute a medical emergency (reiterating psychiatrist or ARNP instructions).
- Assist parents and caregivers to arrange and schedule necessary lab appointments for tests required by psychiatric provider.
- When received, gather and communicate laboratory results to psychiatric provider (and patients if directed by provider) in as timely a manner as possible.
- Share medical information with primary care and specialist physicians at the direction of the psychiatrist or ARNP only, ensure all completed and signed permissions are entered into EHR/patient chart appropriately.
- Maintain diagnostic test results in medical chart.
- Facilitate the processing of prescriptions, document in medical record per FBH protocol, as directed by psychiatric provider.
- Respond as immediately as possible to parents or caregivers calling to report problems with medications, side effects, allergies, etc. Determine need to contact FBH psychiatrist or ARNP, Clinician, PCP, for parent to call 911 or transport to an urgent care facility or hospital emergency department.
- Responsible for the quick and accurate entry of clinical and administrative data into the management information system(s), to include: client registration and demographics, diagnosis, authorizations, clinical services, referral and exit information, outcome data, expenses/concrete costs, purchase orders, credit card vouchers, gift card usage, petty cash, etc.
- Assess the accuracy of clinical and administrative data prior to entry and facilitate corrections with supervisors and staff prior to entry.
- Set up and maintain employee information and qualifications in the database.
- Responsible for initial and monthly Medicaid status checks for all mental health funded consumers in order to verify funding compliance and third party coverage and input all changes into the management information system (MIS). Check error reports in data systems weekly and work with the Family Preservation MIS staff to resolve all errors prior to the end of the month.
- Enter completed consumer satisfaction surveys into the MIS.
- Verify all consumers’ funding and authorization limits monthly through state’s MMIS website and MHO or private insurance website.
- Closes out clients in the MIS when services are completed.
- Maintains up-to-date tracking list of open and closed clients.
- Maintains active and closed clinical charts in secure locations.
- Maintain master copy of all forms (clinical and administrative) and ensure an adequate supply is available to staff.
- Maintain an adequate supply of intake packets and blank clinical charts.
- Monitor compliance with standards for timeliness and completeness of document submission and work with administrative and clinical leadership as it relates to direct service staff participation.
- Provides technical support for therapists and care coordinators in file organization. Assists in consolidation of multiple forms and in ensuring form are complete.
- Types documents per requests.
- Works cooperatively with all staff to comply with contract requirements and best practice regarding disbursement of completed reports.
- Ensure that invoices for services are mailed out by the 15th of the month and emailed to Accounting.
- Determine when closed files need to be shredded.
- Box files according to shredded dates and archive or shred.
- Track boxes to be archived and files that were shredded.
- Respond to requests for files from the community.
- Review and redact confidential information from requested files.
- Track critical timelines for release of requested documentation.
- Ensure second review of records and consult regarding sensitive information and/or unusual records requests.