Clinical Care Outreach Worker

Vinfen•Hyannis, MA

13d•$51,250 - $51,250•Hybrid

About The Position

The Health Outreach Worker collaborates with the Clinical Care Manager (CCM) to provide care coordination for One Care enrollees with complex healthcare needs. The Health Outreach Worker collaborates with Vinfen’s CBFS teams and the One Care Plan’s clinical staff to maximize coordination and integration of care. The Health Outreach Worker also provides administrative support to the CCM.

Requirements

Minimum of two years of experience in Human Services is required.
A high school diploma or equivalent is required.
Driving is a requirement for this position using either a Vinfen van or personal vehicle.
If using a personal vehicle, you must possess and maintain adequate insurance as well as maintain a safe driving record which is subject to annual checks.
A valid driver's license must be presented at the time of employment.
Incumbents must be at least 21 years of age, have maintained a valid US driver's license for at least six months, and must be able to pass a driver's screening background check.
Ability to stand, walk, bend, kneel, stoop, crouch, crawl, climb as this is a very physically active position.
Must be able to lift at least 25 pounds using proper lifting techniques or the use of a two-person lift.
Ability to operate a computer and other office equipment such as a calculator, copier, and printer.
Ability to sit, reach, climb stairs, and maneuver through narrow spaces or hallways.
Ability to assist clients with tasks of daily living.
Ability to remain in a stationary position 50% of the time as needed.
Ability to bend, reach, file, sit, stand, and move around the facility.
Ability to speak, hear, and communicate with clients, staff, and external representatives.
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
First Aid required within two weeks of hire
CPR required within two weeks of hire

Nice To Haves

Experience working with people with psychiatric disabilities, co-occurring disorders preferred.
Care coordination experience preferred.
Bachelor’s degree preferred.
In some cases, experience may be substituted for academic training.

Responsibilities

In collaboration with the Clinical Care Manger (CCM), provide outreach to and engagement of clients enrolled in One Care.
Maintain and update all client documentation including health assessments and care plans in Vinfen’s systems and in the One Care Plan’s electronic medical record as applicable.
With the CCM, facilitate the implementation and monitoring of the clients’ Individual Care Plans (ICP)
Collaborate closely with CCM, PCP and including, but not limited to other healthcare providers and community resources, and facilitate appropriate referrals based on level of care needed to optimize outcomes and minimize risk.
Collaborate with CCM, One Care Plan, PCP and other health care providers regarding changes in services, care transitions, crisis intervention;
Under the supervision of the CCM, conduct home and community-based visits as required
Provide support and education to clients to enhance health and wellness self management.
Assist participants in accessing health care services, through training or by directly accompanying or transporting them to health care visits as requested by the CCM
Serve as a resource for clients, families, and outside agencies requesting information.
Maintain appropriate written and oral communication.
Participate in quality assessment and quality improvement within the scope of responsibilities including data collection, reporting, analyses, and quality management activities designed to improve care and increase effectiveness of the service model.
Actively participate in the evaluation of own performance.
Seek to maintain a constructive work environment and maintain effective communication with others.
Maintain confidentiality of client and employee information.
Travel to meet with One Care clients either in the community or in Vinfen locations, as needed.
Perform other related duties, as required.