Psych Nurse Practitioner - Crisis - Multiple Site

Community Bridges, Inc. (CBI) is an integrated behavioral healthcare agency offering a variety of programs throughout Arizona. CBI provides residential, outpatient, inpatient, patient-centered medical homes, medication-assisted treatment, and crisis services to individuals experiencing crisis, opioid use disorder, homelessness, and mental illness.

About the Role

At Community Bridges, Inc. (CBI), a psychiatric practitioner is an integral specialty for our whole-person approach in our integrated system of physical, psychiatric, and addiction services. The scope of practice of psychiatric practitioner in the inpatient setting will see adults 18 and older, all genders, all socio-economic backgrounds, complex medical history, and co-occurring psychiatric disorders. Psychiatric practitioners at CBI will be expected to provide patient-centered, evidence-based care for patients as well as serve as patient advocates in all health-related matters, including the appropriate use of specialists, health services, and community resources.

CBI is looking for Psychiatric Mental Health Nurse Practitioners (PMHNPs) for the following shifts:

• PMHNP/FNP – Crisis Sobriety Center – AM/PM shifts (Sunday – Tuesday, rotating Wednesday; or rotating Wednesday, Thursday – Saturday).
• PMHNP – (SMI Caseload) – Full time on site, Mesa location; 8AM-4PM Monday – Friday.
• PMHNP – ACT/FACT – Full time on site, Central Phoenix; 8AM-5PM Monday – Friday.

Responsibilities

• Complete Urgent Psychiatric and/or Addiction Medicine evaluations with all patients referred to the 23-hour observation unit from all referral sources including, but not limited to, hospitals, urgent care centers, law enforcement, and other medical practitioners for the purposes of assessment, diagnosis, and treatment recommendations.
• Complete Urgent Psychiatric Assessment and/or Addiction Medicine, Ambulatory Detox, or Physical Health Assessments with patients identified by CBI screening staff.
• Coordinate with other practitioners when admitting, transferring, or discharging a patient to a different CBI program or level of care and document in the medical record to ensure a smooth transition.
• Be available or initiate doctor-to-doctor communication and coordination of care, documenting it appropriately.
• Evaluate all patients on the unit at least daily to provide necessary adjustments in treatment and discharge planning.
• Provide assessment for the appropriate use of seclusion and restraint in accordance with CBI policy, including documentation of current behaviors, known medical conditions, psychiatric/behavioral health conditions, and current medication.
• Write or sign orders for seclusion and restraint immediately if at the facility or within three hours if given verbally, including:
  • The date and time the restraint or seclusion was ordered.
  • The specific restraint or seclusion ordered.
  • If chemical restraint is ordered, the drug names, strength, dosage, route of administration, and symptoms being treated.
  • Maximum duration authorized (not to exceed three continuous hours).
• Complete and document an assessment within one hour after the order for restraint or seclusion takes place, including current behavior, reaction to intervention, patient’s current medical condition, and whether to continue or terminate the restraint or seclusion.
• Write a release order or document a second order at the end of three hours if restraint or seclusion needs to be continued.
• Review cases and discharge plans during rounds with assigned CBI medical staff, documenting and signing full discharge orders and follow-up recommendations within 24 hours of discharge.
• Remain on the unit for the entirety of the scheduled shift; deviations require prior approval from the CMO or designee.
• Complete Application for Involuntary Evaluation and Application for Emergency Admission, with documents reviewed by a qualified practitioner within two hours of receipt for acceptance decision.
• Immediately notify the Admission Coordinator of the decision; applications determined as not acceptable must be staffed with the CBI Medical Director prior to rejection.
• Complete admission orders on admission (in person or verbally to a nurse) and sign by the admitting practitioner within 24 hours of admission.
• Conduct daily staffing and rounds, including:
  • Psychiatric evaluation for everyone admitted to the 23-Hour Observation Unit at minimum once every 24 hours or sooner if clinically appropriate.
  • Review cases with RN and Crisis Specialist during rounds as part of discharge planning process.
  • Document rounds in progress note.
  • Review cases with oncoming practitioner at the end of each shift.
• Maintain treatment of physical health and/or coordination with PCP and other prescribers while in treatment.
• Coordinate with other practitioners when discharging, admitting, or transferring a patient to a different CBI program or level of care, documenting in the medical record to ensure a smooth transition.
• Complete a psychiatric evaluation and document it in the patient file for everyone admitted to the inpatient behavioral health facility.
• Write or sign orders for pain management evaluation if clinically indicated and outside the scope of the attending medical practitioner.
• Provide necessary documentation and treatment for patients under petition or court-ordered treatment.
• Document and sign full discharge orders and follow-up recommendations within 24 hours of discharge, including review of the discharge plan with the patient.
• Evaluate each patient for ongoing mental health/psychiatric care and physical health issues prior to discharge, documenting in the electronic health record.

Requirements

• Complete orientation as directed by CBI, including shadowing another CBI practitioner prior to working with patients.
• Complete a TB skin test prior to working with CBI patients and annually thereafter; results must be submitted to the Credentialing department.
• Obtain and maintain a Suboxone waiver to treat the maximum number of patients for which the practitioner is eligible, maintaining necessary patient data logs as required.
• Provide evidence of CPR/First Aid certification prior to working with CBI patients and submit documentation of renewal every two years to the Credentialing department.
• Participate in quality management initiatives and correct any identified areas of deficiency within 72 hours; exceptions must be approved by the Director of Medical Practice in consultation with the CBI Medical Director.
• Maintain a minimum 85% compliance with documentation requirements.
• Do not cancel patient appointments without prior notification to CBI or refuse to see CBI patient(s) without approval from the medical director.
• Adhere to appointment scheduling protocols assigned by the medical director and monitored by the medical management team.
• Maintain a minimum 85% patient satisfaction; if performance falls below 85%, submit a plan of correction to the Medical Director. If performance falls below 85% for two consecutive months, the practitioner will be removed from the schedule and will not receive compensation during this time.
• Maintain a minimum 75% follow-up rate.
• Complete and document all medication assessments and informed consents by the end of assigned shift or within 24 hours of seeing the patient.
• Review the Controlled Substance Prescription Monitoring Program prior to treatment and coordinate care with other prescribing practitioners.
• Utilize e-Prescribing for all patient prescriptions as established in the CBI electronic medical record.
• Attend regular staffing and rounds on assigned patients; participate in the development of the patient’s treatment plan; provide clinical expertise for the treatment team for patient care; give appropriate direction and provide effective communication about patient care activities.
• Support utilization review activities by clearly documenting admission medical necessity and continued stay necessity, including completion of certification of need for Level I admissions or facilitating completion by a physician if the practitioner is a Nurse Practitioner or Physician Assistant.
• Support utilization management activities by providing reviews when requested by payors.
• Ensure necessary documentation and treatment for patients under petition or court order.
• Promote collaborative patient care by communicating with referring and receiving professionals.
• Attend and actively participate in practitioner meetings; actively participate in any state, regulatory, or accreditation surveys; participate in peer review activities and performance improvement projects.
• Comply with agreed-upon work schedules to provide coverage at the facility and meet clinical and business needs. CBI maintains the right to schedule the Medical Professional at any facility and will make every attempt to establish routine schedules.
• Give a minimum of 60 days’ notice for time off and coordinate with peers to arrange coverage for scheduled shifts. Time off requests will be sent to medicaltimeoff@cbridges.com and, if an employee, also submitted into CBI’s current time and attendance system.
• Notify the Director of Medical Practice and Medical Director in case of an emergency and inability to cover a scheduled shift.
• Adhere to all policies and procedures established by CBI.
• Complete documentation within 24 hours of visit; notify the Director of Medical Practice if documentation is not complete by the allotted timeframe.
• Participate in training new clinical staff of the same specialty or experience if requested, with adjustments made to practitioner schedules during training hours if it impacts patient care.
• Attend educational meetings as deemed appropriate for their specialty, including quarterly practitioner meetings. A minimum of 3 quarterly meetings per year is required. Provide 24-hour notice if unable to attend; contact the Director of Medical Practice as soon as possible in case of unexpected events.

Schedule

• Sunday – Tuesday, rotating Wednesday: 7AM-7PM.
• Rotating Wednesday, Thursday – Saturday: 7AM-7PM.
• SMI Caseload (Mesa location): 8AM-4PM Monday – Friday.
• ACT/FACT (Central Phoenix): 8AM-5PM Monday – Friday.