CARE NAVIGATOR-BILINGUAL

Whitman-Walker Health•Washington, DC

just now•$21 - $26•Onsite

About The Position

The Care Navigator-Bilingual provides specialized support to adults who present with HIV or other adherence-related issues or as transferring care to Whitman-Walker Health. The Care Navigator-Bilingual provides a supportive and empathic relationship to the patient that is harm-reduction focused and serves to facilitate easier access to WWH services and those in the community by meeting with patients face to face, virtually and/or engaging patients over the phone to provide education, counseling, support, and referrals to supportive services within WWH and in the community. This position partners with other community organizations to ensure collaborative service provision without disruption to care. The position requires engagement with HIV- positive individuals who have fallen out of care as well as other populations eligible for added support, partnerships with key community and government partners to provide counseling, care and risk management to these hard-to-engage adults. The position accompanies patients through Whitman-Walker’s services and assists in obtaining external referrals, while also helping the patient to establish a healthy support system and support ongoing retention in care. The Care Navigator-Bilingual coordinates activities with the multi-disciplinary team members supporting the patient’s care plan- Medical Providers, Community Health workers, Behavioral Health staff, and other care team members involved in the care plan, focusing on Motivational Interviewing and action planning in their patient interactions. The Care Navigator-Bilingual will participate in quality improvement (QI) activities to improve health outcomes and is responsible for accurately recording information about the services provided to patients.

Requirements

Knowledge of HIV/AIDS-related illnesses and substance abuse, including current treatment and adherence strategies and knowledge of risk reduction intervention strategies.
Knowledge of chronic health conditions, such as diabetes, hypertension, heart disease, etc., with an understanding of the needs of individuals and families across the primary care continuum
Knowledge of techniques for assessing patients’ needs, developing risk-reduction and referral plans, identifying resources, making referrals, following up to ensure completed referrals, documenting patient interactions, and proactively supporting patients’ pursuit of goals.
Ability to maintain appropriate judgment in interactions with patients and staff
Knowledge of community resources and benefits that impact and/or benefit the targeted patients’ needs, including the Ryan White HIV/AIDS Program and Medicaid.
Understanding of and sensitivity to the needs of individuals with chronic medical conditions, including HIV, mental health and substance use issues, and other conditions.
Ability to work independently with minimal supervision.
Ability to manage time and effort in order to meet strategic objectives.
Knowledge of principles and processes for providing excellent customer service, both internal and external.
Knowledge of all applicable WWH policies and procedures.
Excellent oral and written communication skills.
Knowledge of healthcare information systems with the ability to adapt to new electronic medical record and population health platforms.
Analytical skills necessary for the preparation of accurate, concise and comprehensive reports.
Ability to maintain records and information in an accurate, timely and confidential manner.
Ability to adapt to changes in the service delivery model, re-prioritize as necessary.
Flexibility to work various shifts, including afternoon, evening and weekend shifts.
Commitment to health equity.
Minimum Experience: two or more years of paid work experience providing direct assistance to a diverse population in a public health, healthcare, human services, or other community setting.
Bachelor’s degree in psychology, social work, public health, or related field or at least four years of direct experience required.
Written and oral fluency in Spanish or Amharic required.
Experience working with an ethnically, culturally and racially diverse work staff preferred; ability to work harmoniously with diverse groups of individuals required.

Nice To Haves

Experience with providing HIV and/or STD CTS and HIV outreach, linkage, and retention services preferred.

Responsibilities

Works as part of a multidisciplinary team to provide specialty care to patients with adherence issues and/or unstable disease management status within the health center and over the phone.
Identifies patients in need of specialty adherence care, collaborating with medical and behavioral health providers and support staff to encourage referrals to the adherence team as appropriate.
Provides systematic attempts to engage out-of-care patients, referring to community agencies as needed, to promote collaboration and engagement with WWH’s medical services
Assists and guides patients through services at Whitman-Walker and outside agencies, serving as a representative and advocate of the patient and providing referrals when necessary.
Makes regular contact with patients and develop individualized care plans to promote adherence to treatment plans and assists the patient in establishing a healthy support system that promotes long term retention and addresses barriers to care
Identifies barriers to retention and works with patients overcome obstacles and gaps in care
Prepares narrative and statistical reports as requested.
Maintains up to date and accurate records in the electronic medical record (EMR) system or other data systems.
Ensures patients receive necessary services from community organizations
Follows-up with patients that are identified for being at risk of falling out of care or who have not been recently seen by the practice
Maintains a current resource list of community service organizations
Follow-up in person or through telephone contacts with patients who are hospitalized, have emergency room (ER) visits, miss clinic visits, miss medication refills, or have laboratory results that indicate that patients may not be fully adherent to HIV treatment regimens.
Coordinate with patients’ clinicians, medical case managers, behavioral health providers, or other healthcare providers to ensure that high-quality and culturally competent services are received.
Participate in adherence training and ongoing in-service education arranged by the Whitman-Walker Health to maintain professional knowledge.
Document all work activities according to established standards, collecting data for production in weekly, monthly and annual reports and assists with the creation of those reports as necessary.
Responsibilities include other duties as assigned, including special tasks involved in responding to an emergency event.
Perform and behave in accordance with Whitman-Walker’s mission, cultural norms and core values of dignity, respect, affirmation and humility.
Maintain a respectful, non-judgmental, and compassionate manner with patients/clients/staff.
Demonstrate excellent customer service by identifying and exceeding customer requirements.
Adhere to Whitman-Walker policies and procedures, with special attention given to HIPAA requirements.
Maintain data integrity through conscientious use of relevant tools and employing a system of checks and balances.
Demonstrate organizational skills necessary to multi-task, meet deadlines and re-prioritize as needed.
Participate in organizational quality and performance improvement activities.