Integrated Care Coordinator – Registered Nurse – The Center for Health Care Services – San Antonio, TX


The CCBHC Integrated Care Coordinator – Registered Nurse manages, coordinates and supports the delivery of integrated physical and behavioral health care (including substance use), The target population for services is individuals with severe and persistent mental illness as well as substance use disorders. Using a patient-centered approach which removed silos of care and supports an integrated system; this position will provide whole-person care coordination across medical, behavior and social service community systems.


  • Coordinate trauma-informed care across settings and providers to ensure seamless transitions for patients across the full spectrum of health services, including access to high-quality physical health (both acute and chronic) and behavioral health care, as well as preventative and health promotion needs are addressed as part of the holistic, whole –person, culturally-sensitive health approach.
  • Ensure Care coordination activities are carried out in keeping with the consumer’s preferences and needs for care and, to the extent possible and in accordance with the consumer’s expressed preferences, with the consumer’s family/caregiver and other supports identified by the consumer.
  • Link and refer consumers presenting to clinic to appropriate services (internal and/or external) as requested by the medical team and explain purpose of appointments in clear and simple language. Promote importance of social supports and good lifestyle choices.
  • Provide professional recovery-oriented nursing care to individuals by performing assessments regarding the physical and behavioral health status of the client, completing nursing diagnosis, developing a plan of care, and evaluating consumer’s responses to nursing interventions.
  • Maintain pharmaceutical oversight of medication samples for specified units participating in the program through assigned unit level staff, maintaining accurate account of stock medications, controlled substances, and consumer medications.
  • Establish and maintain routine collaborative meetings between Integrated Care and system partners toward achieving benchmark standards and improving patient care.
  • Educate patients about health issues relevant to their care, community health resources, insurance information, financial assistance, pharmaceutical services, etc.
  • Synthesize information from treatment records, risk stratification, and other sources to assess program enrollees. Apply evidence-based clinical guidelines for behavioral and physical health issues, in addition, knowledge of care coordination techniques in assessing the needs of recipients and determining interventions to address those gaps.
  • Demonstrate excellent customer service and collaborate with physicians, providers, consumers, staff members, visitors, staff, and the health care community.
  • Collaborate with Health Home Team and treating providers using available data, such as exams/assessments scores, participant evaluations, and service observations in order to identify health and wellness needs and develop and implement care coordination plan to address treatment barriers.
  • Creation of informational tools and resources for clients and staff on mental health, physical health, and integrated health services.
  • Development and coordination of all wellness programming (on-site and off-site), including promotion of activities, tracking attendance, evaluations, and topic. Delivery of wellness education programs.
  • Other duties as assigned.


  • Bachelor’s degree or higher in Nursing from an accredited school of nursing
  • Current Registered Nurse Certification to practice in the State of Texas
  • Knows and conforms to the Texas Nurse II Practice Act and the Board’s rules and regulations as well as all Federal, State, and local laws, rules, or regulations affecting the RN’s current area of nursing practice.
  • Must be able to be credentialed with all Center payers
  • Two (2) years’ of nursing experience
  • Proficiency with standard Microsoft Office applications and system databases
  • Must maintain required credentials and mandatory training requirements to ensure compliance with all State regulations and CHCS policies
  • Must maintain a valid driver’s license and automobile insurance coverage, be able to travel as needed, and be able to meet on a consistent basis the driving record requirements of the Company’s auto insurance carrier if you drive your vehicle during company business
  • Must be able to meet the physical requirements to complete SAMA and CPR training including lifting up to 12 lbs. and supporting up to 55 lbs.; bending, stooping and getting on and off the floor without assistance.
  • Must have adequate mobility that requires frequent walking, standing, bending, stooping, kneeling, reaching (vertical and horizontal), using fingers, hands, feet, legs and torso in various care. The employee must be able to regularly lift and/or move up to 40 pounds and occasionally must lift and/or move up to 50 pounds. The employee must be able to occasionally transfer a consumer.


  • Two (2) years’ experience providing similar services
  • Bilingual in English and Spanish
  • Experience with or knowledge of wellness oriented trauma-informed care

Compensation Package

Recruiting and retaining talented individuals is important to us. At the Center for Health Care Services, we are committed to providing our employees with a total compensation package that includes competitive pay, affordable health and wellness benefits, generous paid time off, flexible work schedules, professional development opportunities and generous retirement savings options.

We have wide range of career opportunities and hope you will join us in our mission!

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The Center for Health Care Services is an Equal Opportunity Employer

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