Health Coach

All Ways Caring HomeCare•Cordele, GA

About The Position

The Health Coach provides guidance, support, and resources to clients and their primary family caregivers participating in the CCSP/SOURCE Structured Family Caregiver Program (SFC). In collaboration with the branch RN, the Health Coach assesses the needs of the SFC client and develops a coaching plan. The Health Coach monitors the client and caregiver and provides ongoing assessments, training, and support, adjusting the plan as needed. The role includes coordinating with the Primary Family Caregiver, RN, and Medicaid Waiver Case Manager; identifying relevant community resources and making referrals; conducting monthly and additional visits or contacts according to need; monitoring electronic visit verification records; arranging semi-annual case conferences and joint visits; and reporting concerns about health, safety, or unmet needs to the appropriate care team members. All Ways Caring HomeCare provides individualized care and support intended to help people remain at home while preserving their dignity, privacy, and independence.

Requirements

Two or more years of experience working with elderly, medically frail, and disabled clients, and caregivers.
Excellent communication, computer, and organizational skills.

Responsibilities

Collaborate with the RN to assess whether the SFC client’s goals and needs are being met.
Prepare a coaching plan for the Primary Family Caregiver to guide ADL and IADL care for the SFC client.
Help the client and Primary Family Caregiver determine eligibility for assistance and resources that complement the SFC program.
Coach and train the Primary Family Caregiver to help ensure the client’s goals are met.
Maintain effective communication with the Primary Family Caregiver, RN, and Medicaid Waiver Case Manager.
Use knowledge of community resources related to medical, housing, financial, and social issues; make referrals to other professionals and programs.
Conduct monthly contact visits with the client and Primary Family Caregiver by home visit or telephone.
Provide additional home visits and ongoing caregiver communication according to the waiver member’s and caregiver’s needs.
At least semi-annually, visit the waiver member and caregiver with the waiver Case Manager, with all parties present, to support communication among the care team.
Monitor daily progress notes and tasks through electronic visit verification applications for indications that the caregiver may need additional training or support, and document all caregiver contact.
Schedule semi-annual case conferences with the client, Primary Family Caregiver, RN, and Medicaid Waiver Case Manager.
Send summary reports to the Medicaid Waiver Case Manager monthly, quarterly, and as needed until the external portal is developed.
Alert the SFC provider’s nurse and the CCSP or SOURCE case manager to concerns about the member’s or caregiver’s health, safety, or unmet needs.