Posted in Other about 3 hours ago.
Employment Type:Full time
Shift:
Description:Community health workers represent a key opportunity to engage in advance care planning and symptom management outside of the physician's office and hospital - and often in a more culturally competent way and particularly for communities of color and non-English-speaking populations. CHW's increase "cross-talk" to improve important patient-centered outcomes. As liaisons between healthcare systems and communities, CHWs are uniquely positioned to advance health equity in care for serious illness by improving access to services shown to improve end-of-life outcomes, such as ACP and palliative care.
Serves as a bridge between the hospital, HCMG, ED and community-based health care, government and social service systems. Responsibilities may include assisting individuals, families, groups and communities develop their capacity and access to resources, including health insurance, food, housing, quality care and health information; providing informal counseling, support, and follow-up; making home visits to chronically ill patients, pregnant women and nursing mothers, and elderly; translating and interpreting for clients and health care/social service providers.
Position Purpose
The Community Care Coordinator is a trusted member of the community and has an understanding of the local community being served. Acts as a liaison/link/intermediary and navigator between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.
Provides care coordination, patient advocacy, identifies and refers individuals to community resources, assists in application submission for identified services, and collects and reports confidential information in a computer-based care coordination system.
What you will do:
Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
Conducts and interprets individual assessments to identify non-clinical needs and mitigate any barriers to resources and services
Improves access to health and human services for individuals through in-person interactions, telephone contacts, and coordination of referrals per protocols of ministry's specific programming.
Provides basic education regarding chronic health conditions and health promotion in a way that promotes understanding and self-management by the individual. Reinforces health literacy and educational messages using appropriate tools and supplies within scope of practice.
Facilitates or conducts enrollment in available federal, state and local programs to increase access to health care and support services. Examples include health coverage via the insurance marketplace, Medicaid, Medicare, social security benefits, food, and housing services.
Serves as a liaison between providers and patients to facilitate communication and coordination of services. Coordinates and monitors services, including comprehensive tracking of patients' adherence in relation to care plan objectives per protocol.
Provides in-service education to service providers (including licensed health care professionals and health professions students) relative to healthcare customs/beliefs of the target population and works cooperatively with other community agencies and clinical care teams to promote culturally appropriate services.
Continuously expands knowledge and understanding of community services and resources; maintains frequent contact with community agencies serving vulnerable populations and participates in community meetings.
Uses Social Care tools via TogetherCare (or similar protocols) for care coordination.
Completes timely and accurate documentation of services provided to individuals in electronic medical record or other platform per ministry's protocol. Maintains electronic files, which include consent, release of information, and applicable assessments. Documents notes, activities, service plans, and outcomes achieved by individuals in an effective manner.
Assists with data collection and interpretation relevant to understanding health and social service outcomes.
Practice efficient time management and document time allocation accurately (if applicable).
Other duties as needed and assigned by the manager.
Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
Minimum Qualifications:
Must possess a comprehensive knowledge of the local community based on personal lived experience.
High school diploma or GED. One to three (1-3) years of community involvement experience. Must meet additional state/local requirements as appropriate. Ability to earn a CHW certificate is preferred.
Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively interview patients/clients and accurately record medical information. Ability to effectively present information in one-on-one and small group situations to clients, and other employees of the organization. Ability to effectively relate pertinent information with medical and social service professionals.
Work requires ability to communicate orally and to hear or communicate with target population.
Bi-lingual skills to work with patients in their native language are preferred; certification as a medical interpreter/translator is a plus
Work requires proofreading and checking documents for accuracy.
Basic Life Support (BLS) certification is preferred.
Must be comfortable working and serving in a diverse and inclusive environment, and operating in a collaborative, shared leadership environment with clinical supervision where applicable.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
Position Highlights and Benefits
• Comprehensive benefit packages available, including medical, dental, vision, paid time off, 403B, and education assistance.
• We serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.
• We live and breathe our guiding behaviors: we support each other in serving, we communicate openly, honestly, respectfully, and directly, we are fully present, we are all accountable, we trust and assume goodness in intentions, and we are continuous learners.
Ministry/Facility Information: