BH Services Care Coordinator

Job description

JOB SUMMARY
Based at the Compton Wellness Center, the Behavioral Health (BH) Care Coordinator ensures timely, coordinated, and well-documented patient navigation and care coordination across all Integrated Behavioral Health (IBH) services, including therapy, psychiatry, and recovery services. This role is a key operational partner to the BH Fusion Lab, the department's Dramatic Performance Improvement (DPI) initiative to increase access, quality, and growth. Using
patient-level data and caseload monitoring, identifies and corrects breakdowns that drive no-shows, long cycle times, low provider productivity, and Third Next Available (TNA) appointment delays; coordinates BH case manager and provider schedules; and works alongside clinicians, clinical supervisors, IBH case managers and staff, and Operations to remove barriers to care. The position cross-trains with the Operations department to align BH workflows with front-office, scheduling, and patient-flow processes.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Performs a combination, but not necessarily all, of the following duties:
BH Fusion Lab, Access, and Performance Improvement (approx. 35%)
• Supports BH Fusion Lab goals of increasing access, quality, and growth by helping providers reduce no-shows, increase productivity and completed visits, reduce cycle time, and improve Third Next Available (TNA) appointment metrics.
• Tracks and analyzes patient-level and site-level data on patient flow, scheduling, no-show, and cancellation patterns, referral completion, and outcomes; identifies breakdowns and recommends and implements corrective actions.
• Provides day-to-day oversight of provider schedules across all IBH services, including template optimization, appointment reminder and confirmation workflows, waitlist and cancellation backfill, and same-day access.
• Participates in rapid-cycle improvement (PDSA) work, learning sessions, huddles, and data reviews; helps standardize and spread successful workflows across IBH sites.
• Supports the improvement of service delivery across all IBH services, including recovery services, and contributes to grant deliverables and quality measures (e.g., UDS depression screening and follow-up, HEDIS behavioral health measures).

Team Collaboration and Cross-Departmental Coordination (approx. 20%)
• Works alongside clinicians, clinical supervisors, psychiatry providers, peer recovery specialists, Community Health Workers, grants teams, and all departments, especially Operations, to coordinate care and resolve barriers to access.
• Cross-trains with the Operations department to understand front-office, call center, scheduling, registration, and eligibility workflows, and to align BH processes with clinic operations.
• Coordinates care monitoring and follow-up schedules with families and maintains contact between families and service providers to monitor progress.
• Attends and contributes to staff meetings, case conferences, interdisciplinary team meetings, and open discussion forums; fosters a collaborative, patient-centered, and advocacy-oriented team environment.
• Participates in continuing education and professional development and maintains current knowledge of behavioral health navigation, care coordination, and payer requirements.

Patient Navigation and Care Coordination (approx. 25%)
• Provides navigation support across all IBH services, including warm hand-offs from primary care, engagement of patients with positive screens, and re-engagement of patients lost to follow-up.
• Coordinates access, and internal and external referrals, and confirms closed-loop referral completion.
• Links patients to community resources (housing, food, benefits, legal, employment, education) and Medi-Cal managed care benefits such as CalAIM Enhanced Care Management (ECM) and Community Supports where eligible; serves as liaison between patients, families, and community partners.
• Ensures continuity of care across IBH programs, primary care, psychiatry, recovery services, and transitions of care (e.g., post-hospitalization, crisis stabilization, residential treatment).
• Facilitate patient IBH record and form requests, obtain ROI and upload all documents to patient chart.
• Provide Spanish interpretation as needed.

Screening and Assessment (approx. 10%)
• Ensures patients have completed intake of paperwork, consents, releases of information, and program enrollment forms prior to initial assessment.
• Monitors screening and re-screening completion rates and follow up on missed or overdue measures.

Documentation Quality (approx. 10%)
• Maintains accurate, complete, and confidential records, client tracking logs, and data collection in compliance organizational requirements and documentation standards.
• Maintains regular contact with patients through phone, text (where consented), and outreach; documents all contacts and attempted contacts.
• Prepares monthly caseload, productivity, and outcome reports for IBH leadership and grants teams.
• Maintain Time Study, if necessary.

QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education :
Bachelor's Degree
Experience: (Required)
• Three years' experience in social service setting providing targeted care management to multi-ethnic communities.

Preferred:
• Certified Case Manager (CCM), Community Health Worker certification.
• Bilingual English/Spanish strongly preferred, consistent with the patient population served.

Licensure/Certification:
• Employees are responsible for maintaining individual certifications as required by job function or by law and provide verification and recertification when requested by management.

St. John’s Community Health is an Equal Employment Opportunity Employer