Primary Care Coordinator CCBHC

Job Summary:

The Providence Center Primary Care Coordinator supports the integration of primary and behavioral healthcare services for clients enrolled in the Certified Community Behavioral Health Clinic (CCBHC) program at The Providence Center. This position serves as a liaison between internal behavioral health teams and external primary care providers to promote coordinated, client-centered care. The Coordinator ensures that services align with CCBHC federal standards, quality metrics, and reporting requirements.

Duties and Responsibilities:

Act as a liaison between primary care providers and behavioral health teams, promoting integrated, holistic care (examples: Providence Community Health Centers, RI Free Clinic, Center for Primary Care, Integra, etc.).

Coordinate appointments, referrals, and follow-up services between clients, primary care providers, and behavioral health teams.

Identify clients eligible for or in need of primary care services and ensure timely connection to appropriate providers.

Support CCBHC-required activities, including coordination of comprehensive care planning, care transitions, and screenings (e.g., metabolic monitoring, tobacco use, BMI, blood pressure, etc.).

Document all care coordination activities in the Electronic Medical Record (EMR) in accordance with agency, state, and CCBHC documentation standards.

Monitor and help improve client compliance with preventive screenings, chronic disease management, and follow-up care.

Assist with meeting federal CCBHC quality measures, such as engagement in primary care and metabolic lab results.

Maintain accurate records of client primary care activities to meet CCBHC reporting requirements and quality standards.

Communicate medical updates to appropriate teams in a timely manner.

Participate in team meetings, providing updates and helping develop treatment plans as they pertain to medical care.

Establish and maintain working relationships with external medical providers, clinics (including but not limited to health centers like Providence Community Health Centers), and hospitals.

Collaborate with CCBHC leadership to identify barriers to care and help implement solutions to improve health outcomes.

Assist clients in navigating medical systems, understanding health recommendations, and adhering to treatment.

Participate in CCBHC training and development opportunities and stay informed of changes to CCBHC regulations.

Support data collection and quality improvement initiatives related to CCBHC metrics and client outcomes.

May be required to travel locally to accompany clients (including potentially transporting clients to appointments) or attend meetings with partner agencies.

Adhere to all HIPAA regulations, as well as applicable Rhode Island and federal privacy laws, ensuring confidentiality and security of patient information and protected health information (PHI).

Other duties as assigned.

Requirements:

Bachelor's Degree Required.

Minimum 1-to-3 Years of experience in health, behavioral health, case management, or community services.

Familiarity with CCBHC standards and integrated care models preferred but not required; training provided.

Strong organizational and communication skills.