Behavioral Health Homes Registered Nurse

Systems Navigator (Behavioral Health Homes Registered Nurse)

Be the backbone of hope and healing. At Minnesota Adult & Teen Challenge, every role matters in helping people overcome addiction and find a new path forward. Whether you're working directly with clients or supporting behind the scenes, your contributions make recovery possible. In return, we offer a values-driven workplace, supportive managers, and opportunities to grow. That commitment has earned us recognition from Newsweek as a Best Addiction Treatment Center and eight straight Star Tribune Top Workplace awards.

Job Summary

The Systems Navigator (Behavioral Health Homes Registered Nurse) takes the lead in conducting assessment and planning for Behavioral Health Home Services, meeting with each member as necessary to assess needs, review progress, make and assist with referrals, and provide health and wellness education, direct support and advocacy for individuals served.

Essential Job Responsibilities:

To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. The essential functions include the following:

• Conduct an Intake Interview and Brief Needs Assessment for each person referred.
• Ensure that the person enrolled in BHH services receives information about the purpose of BHH services and the person's rights and responsibilities
• Providing coaching to members and their identified supports regarding BHH services
• Notify the Managed Care Organization (if appropriate) the patient is being enrolled in a BHH using the form provided by the Department of Human Services.
• Coordinate a meeting for each person referred with the Integration Specialist.
• Meet with the client, gather information and complete the Health and Wellness Assessment.
• Using a person-centered interview, and information gathered in assessments, develop measurable goals and objectives for the Health Action Plan. Submit to the Integration Specialist when complete, for review and approval, and obtain the individual's signature.
• Update the health action plan at least once every six months, or more frequently if there are significant changes to a person's needs or goals.
• Conduct regular Progress Reviews on the Health Action Plans for each individual at the intervals required in the Behavioral Health Home Services policy and procedure guide and update the plan every six months for individuals who are continuing services.
• Attend regular (no less often than monthly) meetings with the Integration Specialist and Qualified Health Home Specialists to consult and collaborate, identifying priority cases for discussion based on member needs.
• Help individuals prepare for and attend recommended health care, behavioral health, social services, vocational supports, and other appointments. With members, identify potential needs and barriers to accessing necessary services and arrange for necessary supports (arranging transportation, attending with, advocating on behalf of individuals, or teaching self-advocacy skills).
• Develop competency in providing member Health and Wellness Education using resources approved by the Integration Specialist.
• Develop and demonstrate competency in using Motivational Interviewing skills to help individuals overcome ambivalence or resistance in pursuing positive health and wellness goals.
• Refer people to resources appropriate to their screening results. Know processes for referrals related to substance use disorder and ensure follow-through with referrals. Demonstrate capacity to integrate a treatment plan for substance use disorder into comprehensive care planning.
• Have capacity to assess a person's readiness for change and his or her capacity to integrate new health care or community supports into his or her life.
• Develop an articulate health and wellness vocabulary that will engender confidence in providers of health care and social services to the individuals we serve in common. Nurture positive and productive partnerships with providers with proactive communication and by providing information and education about the Behavioral Health Home Service, its purpose, goals and benefits to persons served.
• When individuals receive other services within the agency, take the lead in facilitating collaboration to optimally support the individual's recovery and health goals. Offer and schedule and facilitate individual Recovery Team Meetings in conjunction with Health Action Plan and other Treatment Plan development or updates.
• Manage time effectively to ensure quality and compliance with all assessment and planning requirements.
• Maintain accurate and complete records of all services provided and health care records of persons served.
• Report incidents, potential maltreatment, and sentinel events immediately (within 24 hours) to the Integration Specialist.
• Meet weekly with Qualified Health Home Specialist partner(s) to review the previous week and collaborate on upcoming needs of individuals served. Review contact records with all persons served to see that they, or a primary care provider for them have had contact within the last 30 days and that all identified needs have been met.
• Participate in ongoing Career Development, working toward career and competency improvement goals identified in the plan.

Required Skills & Experience (Minimum Qualifications):

• Current Minnesota Registered Nurse (RN) license in good standing in the state of Minnesota.
• Minimum three years of clinical nursing experience in behavioral health, community health, home care, case management, care coordination, or population health.
• Knowledge of Behavioral Health Home (BHH) requirements, social determinants of health, and community resources preferred.
• Demonstrated experience conducting comprehensive assessments, developing person-centered care plans, and coordinating services across healthcare and community systems.
• Knowledge of community resources, healthcare systems, benefits, housing supports, and care coordination.
• Ability to perform care planning, coordinate services, monitor goals, and support client engagement.
• Comfort and compassion in working with individuals facing life-controlling challenges, such as mental health issues and addiction.
• Demonstrate MnTC's mission, Culture of Honor, core values, and Putting Honor in Action principles through daily interactions, fostering a welcoming, respectful, and relationship-centered environment.
• At least 1 year of freedom from problematic substances.
• Must pass a DHS background study as required under MN Statutes, Chapter 245C and 245G.

Physical Requirements:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

• Prolonged periods of sitting at a desk and working on a computer.
• Prolonged periods of standing, bending, and reaching
• Must be able to lift up to 25 pounds at times.

Target Compensation (Negotiable based on qualifications):

$67,000 to $75,000 range (annual salary)

Our robust benefits package includes medical, HSA, dental, vision, PTO, dependent care FSA, disability, life insurance and 403b retirement plan.

We seek to recruit, develop and retain the most talented people from a diverse candidate pool in order to successfully meet our mission of helping every Minnesotan find help and healing from addiction.

Mn Adult & Teen Challenge is an Equal Opportunity Employer and does not discriminate based on any category protected by federal, state or applicable laws.

Reasonable accommodation can be provided upon request.