The MAT Care Coordinator is responsible for the coordination and care of patients receiving Medication Assisted Treatment. The position responsible for performing a variety of duties including coordination with prescribing Primary Care providers and Behavioral Health Clinicians at Four Rivers Community Health Center. As part of integrated support service, the MAT Care Coordinator will provide for the planning, coordination and transition of care. In addition, assisting patients with the coordination of internal and external services and resources including counseling services, crisis intervention and financial assistance etc.

ESSENTIAL JOB RESPONSIBILITIES:

• Work in collaboration with medical providers, behavioral health providers, care team members, and referral partners in the community to coordinate all aspects of patient care related to medications for addiction treatment of substance use disorders.
• Serves as the primary point of contact to MAT services to address patient needs.
• Conduct initial Case Management intake for all patients seeking treatment of substance use disorders
• Responsible for monthly contact with assigned patient caseload and appropriate documentation of all patient interaction and data in EHR in a timely, accurate and thorough manner
• Conducts pre-visit planning for each encounter of assigned patients to ensure the patient is in compliance with the MAT Program guidelines.
• Clerical responsibilities are assigned that include but are not limited to patient care plan, up-to-date MAT contract, consents, completing forms, sending/receiving patient medical records, scheduling appointments, assisting with insurance coverage and patient demographics, answering phone calls and WELL messages, laboratory testing, referrals, medication, review PDMP, EHR MAT registry etc.
• Provide appointment or warm hand off to internal services when indicated, such as for eligibility, case management, for housing, prenatal care, alcohol and drug counseling, and other services as indicated.
• Review and coordinate internal and external referrals into the program in a timely manner
• Actively collaborate with other clinical and non-clinical staff to ensure care is proactive and coordinated among care providers and care settings. This collaboration can include attendance in team huddles, training, and communication.
• Schedule transportation services and/or distribute gas cards or food vouchers as needed and when these resources are available.
• Follow state and federal guidelines for providing care to patients with substance use disorders in collaboration with prescribing primary care providers and participating pharmacies.
• Work closely with Peer Support to engage patients lost to follow up and arrange for re-entry into treatment when requested by patient.
• Participates in quality improvement activities on own initiative and as assigned.
• Organizational responsibilities as assigned including respecting/promoting patient rights; responding appropriately to emergence codes; sharing problems relating to patients and/or staff with immediate supervisor.
• Recommends, assists in development, and implements improvements in all areas of responsibility
• Other duties as assigned.

CORE COMPENTENCIES:

Patient-Centered Care - Recognize the patient as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs.

Teamwork and Collaboration - Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care

Quality Improvement - Use data to monitor the outcomes of care processes and use improvement methods to continuously improve the quality and safety of health care systems.

Safety- Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.

MINIMUM QUALIFICATIONS:

Bachelor's degree in Social Work, Psychology, Health and Business Administration or other human service field preferred.

Job Type: Full-time