Yale New Haven Health System


US-CT-New Haven
Job ID
Position Type
Full Time Benefits Eligible
Scheduled Hours
Work Schedule
Work Days
Work Hours
8:30AM - 5:00PM
Work Shift
Requisition ID


To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values—integrity, patient-centered, respect, accountability, and compassion—must guide what we do, as individuals and professionals, every day.

The PCMH Clinical Behavioral Specialist reports to the Director of Patient -Centered Practice Transformation and works in collaboration with physicians, Care Coordination staff, practice management staff, Patient Navigators, pharmacists, and other healthcare professionals to develop, implement, evaluate and revise the delivery of behavioral health services to the NEMG patient population.


The PCMH Clinical Behavioral Specialist is an experience professional who is the clinical expert in the assessment and treatment of adult and geriatric patients in a variety of outpatient settings in the Northeast Medical Group network. As the clinical expert, the scope of practice includes,but is not limited to, diagnostic assessment, counseling, psychotherapy, brief treatment, behavior health

modification, mental health consultation, teaching/mentoring, projects, in-service, clinical practice enhancement, and

participation in research.


This position will be responsible for collaborating directly with providers, vendors, and community agencies to create a consistent and coordinated delivery of behavioral health services. Actions will be diected toward the goals of prevention, assessment, risk reduction, and health status improvement for high risk patient populations. Activities include, but are not limited to systemic analysis of behavioral health data, care plan development, behavioral health education and advocacy, and collaborating with system and community partners to promote the health of a population. The PCMH Clinical Behavioral Health Specialist works from within the context of a patient-centered, team approach, and in continuous partnership with families and physicians to promote: timely

access to needed care, comprehension and continuity of care, and the enhancement of patient and family wellbeing. Success will be measured by the results of the process and outcome performance measures of the population of patients in the specified practices.






    1.  Demonstrate and apply knowledge of the philosophy/principles of comprehensive, community based,

    patient-centered, developmentally appropriate, culturally sensitive behavioral health services

    2.  Provide referral and follow-up to individuals and families who are members of a vulnerable population and /or

    high risk groups. Evaluates outcomes, effectiveness of plan, and makes changes as necessary on micro and

    macro levels.

    3. Manage a caseload of high risk patients to assure coordination of behavior health services.

    Engage individuals and families in a plan of care that addresses their identified behavioral health deficits and

    issues. Provide education and counseling to individuals and families that are adapted to their unique needs ,

    lifestyle, cultural and socio-economic situation.

    4.  Document patient assessment and intervention data in medical records. Use established electronic medical

    record forms, databases and documentation practices.

    5.  Collaborate in development and delivery of programs and activities for individuals, families and population

    groups that promote behavioral health.

    6.  Collaborate in the development of and contributes to individual, team, and department quality improvement

    and evaluation activities.

    7.  Advocate on behalf of vulnerable individuals and populations; participates in assessing and evaluating

    behavioral health services to ensure that people are informed of available programs and services and are

    assisted in the utilization of those services.

    8.  Contribute to a work environment that fosters ongoing educational experiences for colleagues, healthcare

    professionals and members of the community.

    9.  Assume responsibility for own professional growth and development by pursuing education, participating in

    professional committees and workgroups.

    10.  Collaborate in the development of evidence-based medical practices.

    11.  Utilize appropriate methods for interacting effectively and professionally with persons of all ages and from

    diverse cultural, socioeconomic, educational, racial and ethnic backgrounds, sexual orientations, lifestyles

    and physical abilities.



EDUCATION:Master's Degree from an accredited school of Psychology, Behavioral Health, Social Work, Nursing or other related



EXPERIENCE5 years of experience, post Master's degree in clinical specialty.


SPECIAL SKILLS:  Core philosophy or values consistent with a patient-centered approach to care. Culturally effective capabilities

demonstrating a sensitivity and responsiveness to varying cultural characteristics and beliefs. Strong interpersonal

and leadership skills. Participates effectively as a team member. Bilingual desired.


ACCOUNTABILITY: Accountable for coordinating the behavioral health care of a panel of patients within the NEMG delivery networks .

Hold other members of the health care team accountable for their role in care processes across the continuum of

care, focusing on the ambulatory setting. Accountable for ensuring high quality patient care that is coordinated ,

efficient, and efficacious and supports desired clinical and financial outcomes .


COMPLEXITY:  In personal and job-related decisions and actions, consistently demonstrates the values of integrity (doing the right

thing), patient-centered (putting patients and families first), respect (valuing all people and embracing all differences),

accountability (being responsible and taking action), and compassion (being empathetic).  Must possess extensive clinical expertise to be recognized as a credible clinician by physicians and other members of the health care team. Demonstrated ability to understand and anticipate the impact of practice and system issues on efficiency of care and cost of care. Must be able to negotiate with all members of the health care team and other departments to expedite care and services. Must be knowledgeable about the research process and the ability to utilize as well as conduct research.


LICENSURE/CERTIFICATION: APRN or LCSW or other behavioral health certification and Valid Driver's License.


SPECIAL WORKING CONDITIONS AND PHYSICAL DEMAND:  MMR is required. Varivax (chicken pox vaccine) or evidence of prior chicken pox is required. Hepatitis B (or signed declination) is required for those with potential exposure to blood/body fluids.

Tdap and influenza vaccination are strongly encouraged.  Must be able to travel to various delivery network locations.



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