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Director, Nathaniel Wellness Program



Reports to: Nathaniel Clinic Director

Overview: The Director of the Nathaniel Wellness Program is a senior member of the Nathaniel Clinic staff leading the integration of primary care services in the Nathaniel Clinic outpatient mental health clinic. The integrated services are being implemented by CASES and our partners the Institute of Family Health (IFH). The Director will direct the treatment and administrative work of the SAMHSA Primary Care Behavioral Health Integration (PCBHI) grant delivering integrated services to adults with serious mental illness. Managing the work of a multidisciplinary team (family nurse practitioner, RN care coordinator, peer coach, diabetes educator and substance use counselor), the Director ensures the coordination and integration of mental health and primary care treatment. This position requires an effective leader with thoughtful and pragmatic problem-solving skills. The Director will develop integrated clinical workflows and clinical registries to facilitate an agency-wide cultural shift towards integration and shared accountability for consumer' whole health. The Director must have relentless commitment to shared treatment planning and shared decision-making between mental health and primary care staff. The Director must be competent in the effective use of health information technology (HIT) and data to manage and improve the quality of care. The goal of the Nathaniel Clinic is to offer mental health treatment in Central Harlem to criminal justice involved youth and adults. Mission driven candidates committed to social justice and the goal of increasing public safety through innovative services that reduce crime and incarceration and improve health will be ideally suited for this position.


• Supervise the work of the PCBHI multidisciplinary team.
• Provide clinical and administrative supervision to PCBHI staff and interns.
• Supervise the CASES employees on the PCBHI team and work closely in collaboration with the IFH Family Nurse Practitioner (FNP) to provide leadership around the team's integration into the Nathaniel Clinic's operations and services for consumers receiving Assertive Community Treatment (ACT).
• Lead organizational, weekly multidisciplinary meetings and case conferences with all providers (MH, primary care, pharmacy, care managers, housing providers, and criminal justice providers) serving consumers for joint treatment planning, shared decision-making, and complex care review.
• Provide psychotherapy, initial comprehensive assessments, and complex care management to a small caseload of PCBHI consumers.
• Ensure evidence-based practices, Wellness Self-Management Plus, smoking cessation and weight loss services are effectively implemented.
• Maintain all quality, compliance, utilization review and regulatory controls to ensure appropriate and high quality services, in consultation with Nathaniel Clinic Director, IFH leadership and FNP, consumer representatives, advisory group, Evaluator, Managed Care Organizations and Health Homes.
• Review case records and ensure the quality and timeliness of clinical documentation in accordance with CASES and IFH standards
• Lead quarterly Coordination Team performance meetings
• Collaborate with external evaluator and ensure integrity and quality of program data
• Routinely use data including PSYCKES quality health indicators, Managed Care Organization (MCO) data, and program level data to monitor, track, and analyze the effectiveness and cost of services.
• Ensure PCBHI consumers are engaged in Health Home care management.
• Assist team members through individual and group conferences in analyzing case problems, improving services and consumer outcomes.
• Ensure appropriate team follow-up and discharge coordination following consumer ER visits and inpatient stays.
• Ensure development of clinical registries in CASES' Qualifacts CareLogic EHR, workarounds and interface practices with IFH EHR, and effective information sharing procedures with Health Homes, Regional Health Information Organization (RHIO), to track and manage integrated treatment.
• Oversee productivity benchmarks and monitor performance each month against program goals and present findings and solutions in the monthly executive clinic performance meeting.
• Recommend and develop policies and procedures to promote integrated care within the Nathaniel Clinic and for ACT consumers.
• Interface with IFH leadership, and CASES' quality assurance, corporate compliance, EHR, strategic planning & analysis, fiscal/business staff to ensure services are effectively implemented and are sustained.
• Main liaison with SAMSHA federal funding agency, responsible for writing quarterly reports and liaison with program evaluator on data submission.
• Support PCBHI sustainability activities with active participation in evaluation, outreach, engagement, and presentations to MCOs, Delivery System Reform Incentive Program (DSRIP) Performing Provider Systems, NYS and NYC mental health and health agencies, and Health Homes.
• Provide 24-hour emergency and crisis intervention rotating phone coverage.
• Deputize for the Nathaniel Clinic Director as needed.
• Provide culturally competent services in accordance with CASES policies.
• Any other duties as required by supervisory and directors.


• Registered Nurse (RN) or LMSW/LCSVV with extensive medical experience
• At least one year as a supervisor and experience working with adults with serious mental illness and co-occurring substance use disorders
• Proficient in behavioral health and primary care integration models
• Ability to work effectively with diverse team and remain highly organized
• Proficient in computers and Electronic Health Record (EHR)
• Fluency in Spanish preferred


Salary: Competitive full-time 35-hour week with excellent benefits

Benefits: Here at CASES we offer benefits that will assist you in making the most of your career and your life. Our programs include health and wellness insurance which is offered through Aetna. A retirement 403(b) plan is held with Principal, education, and training. Additionally, our portable ancillary benefits are offered through Aflac, Legal Shield, and ADP Flexible spending account; which is then deducted through payroll along with commuter benefits, additional short-term disability, cancer, additional income protection, hospitalization coverage, and identity theft protection.


Please apply through:

Posted on 11/09/17; CVMHA ID #11557