Southwest Network

Southwest Network is a non-profit organization that provides
behavioral health services to children, adults and families throughout
Maricopa County, Arizona. Focusing on the strengths of the individual,
Southwest Network partners with agencies in the community to
develop service plans that offer hope, encourage responsibility,
provide education, and support goals for recovery and self-sufficiency.
These community partnerships and their own commitment to success
are helping people throughout the county lead lives of value.
 

As a member of the clinical team, participates in the assessment and service plan development and implements services to recipients in accordance with their individualized service plan (ISP). Communicates and documents recipient’s progress toward their recovery. Creates and maintains a focus with each recipient in four areas: recovery, community, employment, and co-occurring disorders.

Primary Job Responsibilities

 
 

 

·         Works collaboratively with the clinical team to engage, educate, communicate, and coordinate care with recipient, their family, behavioral and general medical and dental health care providers, community resources and others to ensure that all services prescribed in the individualized service plan (ISP) are implemented.
·         Works with recipients to develop a role for themselves outside of their mental illness, while focusing on expected outcomes of increased employment, Meaningful Community Activity (MCA), independent living status, and social network, as well as decreased substance use/abuse.
·         Provides supportive services including, but not limited to, the following:
  • Assistance in maintaining, monitoring and modifying covered behavioral health services;
  • Brief telephone or face-to-face interactions with a recipient, a recipient’s family, or other involved party for the purpose of maintaining or enhancing recipient functionality;
  • Assistance in finding necessary resources other than covered services to meet basic needs;
  • Serves as a point of contact and to ensure ongoing collaboration including the communication of appropriate clinical information with other involved parties as appropriate and coordination of care with a recipient’s family, behavioral and general medical and dental health care providers, community resources, and other involved supports including educational, social, judicial, community and other State agencies;
  • Ensures all appropriate referrals for identified services on the service plan are made and coordinated with service providers via contracted network providers or community resources; Ensures all covered services identified on the service plan are evaluated and updated monthly.
  • Provides outreach and follow-up of services including, but not limited to, crisis and missed appointments to ensure adequate resources are available and in place;
  • Participates in staffing, case conferences or other meetings with or without the recipient or recipient’s family participating;
  • Coordinates referral or completes the screening and assessment on all recipients on caseload for financial entitlements (AHCCCS, SSI/SSD etc.); completes AHCCCS applications on all recipients on caseload meeting criteria;
  • Ensures that transfers to out-of-area, out-of-state or to an Arizona Long Term Care System (ALTCS) contractor, are coordinated as applicable;
  • Ensures the development and implementation of transition, discharge, and aftercare plans prior to discontinuation of behavioral health services.
·         Performs all case management functions associated with caseload including participating in the assessment and service planning processes; including identifying the need for further or specialty evaluations.
·         Collaborates with the recipient and recipient’s family or significant others to implement an effective service plan, explaining the available clinical options to the team, including the advantages and disadvantages of each option.
·         Maintains the recipient’s comprehensive clinical record, including documentation of activities performed as part of the service delivery process (e.g., assessments, provision of services, coordination of care, discharge planning).
·         Provides continuous evaluation of the effectiveness of treatment through the ongoing assessment of the recipient and input from the recipient and relevant others resulting in modification to the service plan as necessary.
·         Pursues best practice outcomes for recipient with mental illness including continuing education, employment, independent housing and community tenure.
·         Provides transportation to recipient as appropriate and determined by the clinical team utilizing employee’s personal vehicle. Conducts frequent community visits, including but not limited to, private homes, jail facilities, office/clinic locations, hospitals, and group homes. (See Working Conditions: Driving and other requirements).
·         Adheres to minimum productivity and documentation requirements.