HHC Coordinator, Integrated Care - MAT/SBIRT
at Heartland Alliance

Date Posted: 11/13/2019

Job Description

Summary: The Coordinator, Integrated Care – MAT & BIRT ensures grant requirements are met for the programs and coordinates patient care. S/he completes comprehensive assessments of clients’ substance use history, administers, substance use screenings, and logs and tracks MAT patients. S/he manages MAT program data and completes data reports; schedules patient appointments and follow-ups; and provides patient outreach. S/he documents treatment and discharge plans, clients’ progress and response to treatment, and maintains related records and charts. Provides case management and contributed to client care monitoring. Duties may vary by work site.

Essential Duties and Responsibilities:

• Provides support to the MAT/SBIRT team ensuring grant requirements are met for the MAT program.

• Coordinates patient services with members of multidisciplinary team.

• Manages and maintains the clinic schedule for all MAT locations.

• Ensures all patients are screened for substance use using evidenced based tools.

• Logs and tracks MAT patients.

• Manages MAT data and create data reports.

• Works as part of a multidisciplinary team, communicate effectively with primary care providers/clinical staff to provide patient care and coordination to improve patient outcomes.

• Works with providers in other care settings (hospitals, emergency rooms, treatment centers) to improve communication during transitions of care.

• Helps MAT patients access social services that will help them address the social determinants of their health.

• Ability to work effectively with a diverse patient and staff population and use of interpreter services as needed.

• Establishes and maintains professional and therapeutic relationships within the standards of patient profiles, confidentiality laws and newest clinical research available.

• Attends educational trainings in order to maintain licensure.

• Coordinates with FQHC staff to ensure supplies (i.e. urine toxicology kits) are adequately stocked.

• Produces monthly reports on quality metrics.

• Performs on-site toxicology testing per clinic protocols and maintain record of testing.

• Adheres to professional standards as outlined by governmental bodies, appropriate professional associations, private funding sources, organization plans/policies and organization’s guidelines. Participates in periodic evaluative reviews and/or in house and external staff trainings.

• Travels between clinic sites.

• Other duties as assigned.


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 and/or Experience:

• Bachelor’s degree or equivalent experience required.

• Certification or licensure preferred such as Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), Certified Alcohol & Drug Counselor (CADC), Certified Peer Recovery Specialist (CPRS), National Certified Recovery Specialist (NCRS), Assessment & Referral Specialist (CARS) and/or Recovery Support Specialist (CRSS). Applicants not certified or licensed must be willing to obtain same.

• American Heart Association or American Red Cross CPR certification required upon hire and throughout employment.

• Experience working with people who use drugs and/or have behavioral health needs preferred.

• Knowledge of Trauma Informed Care, Harm Reduction, and/or Motivational Interviewing theory and practice preferred.

• Candidates with lived experience with substance use are encouraged to apply.

Communication Skills:

• Bilingual English/Spanish proficiency preferred.

• Excellent written, interpersonal and oral communication skills.

• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of consumers or coworkers.

• Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.


• Ability to use computers and other electronic technology to receive, organize, prioritize, and transmit information; general knowledge and ability to use Outlook, Word and PowerPoint.

• Demonstrated written and verbal communication skills: ability to read and interpret documents, prepare routine reports and correspondence, and speak effectively.

• Excellent communication skills required to interact with all levels of internal and external sources, to convey information, manage difficult situations and represent HHC favorably.

• Excellent command and consistent use of AIDET principles.

• Ability to implement and maintain compliance with organization policies and procedures.

• Capacity to work effectively as part of a team required. Must be energetic, motivated, resourceful and self-directed. Must be organized, detail-oriented and have flexibility to manage multiple tasks simultaneously.

• Ability to interact with diverse groups of people of various disciplines and educational levels required. Ability to work as an effective team player.

• Ability to deal with problems involving several concrete variables in standardized situations.

• Comprehension of and appropriate use of basic medical terminology, application of third party payer guidelines and concepts related to quality assurance measures. Compliance with organization policies and procedures.

Physical Demands: 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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to talk and hear.

• The employee is frequently required to sit, use hands to handle or feel, and reach with hands and arms.

• While performing the duties of this job, the employee is occasionally required to stand, walk, climb or balance, and stoop, kneel, crouch or crawl.

• The employee must occasionally lift and/or move up to 10 pounds.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The noise level in the work environment is usually moderate.

• The employee may be required to remain on premises during breaks and/or meal periods and may be required to stay on premises until his/her replacement arrives.

HHC Mission, Vision & Culture

Mission: Our mission is to improve the well-being of the communities we serve by providing accessible, high-quality healthcare. At HHC, we believe that healthcare is a human right and we aim to deliver healthcare from the heart every day.

Vision and Strategy for Practice Transformation: Our vision is to be national leader in community-based healthcare by advancing innovative service models and patient-centered best practices. To accomplish our goals, we know we can’t work harder but we must work smarter, and we are strongly committed to creating a more patient-centered care model using a two-pronged strategy: the team-based care movement and the innovation center.

Healthcare from the HEART Culture and Values:

Humility: We believe all voices matter.

Empathy: We have compassion for the experience of others

Adaptability: We adopt an openness to learning and belief in our unlimited potential

Relationships: We foster respectful relationships as they are the foundation of collaboration

Trust: We assume good intentions in our interactions with each other

Heartland Health Centers makes all hiring and employment decisions, and operates all programs, services, and functions without regard to race, receipt of an order of protection, creed, color, age, gender, gender identity, marital or parental status, religion, ancestry, national origin, amnesty, physical or mental disability, protected veterans status, genetic information, sexual orientation, immigrant status, political affiliation or belief, use of FMLA, VESSA, military, and family military rights, ex-offender status (depending on the offense and position to be filled), unfavorable military discharge, membership in an organization whose primary purpose is the protection of civil rights or improvement of living conditions and human relations, height, weight, or HIV infection, in accord with the organization's AIDS Policy Statement of September 1987

Job Snapshot

About Us

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Heartland Alliance—the leading anti-poverty organization in the Midwest— believes that all of us deserve the opportunity to improve our lives. Each year, we help ensure this opportunity for nearly one million people around the world who are homeless, living in poverty, or seeking safety. Our multicultural staff are passionate about our mission and make Heartland Alliance a dynamic and exciting place to develop your career.

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