On-Call Patient Navigator

Central City Concern•Portland, OR

5d•Onsite

About The Position

The On-Call Patient Navigator fills in as a critical member of the Recuperative Care Program’s multidisciplinary team, providing intensive case management for patients during their program stay. The role supports people experiencing homelessness who have medical support needs, including individuals with acute or chronic medical conditions and co-occurring substance use or mental health needs. The program partners with Portland-area hospitals and clinics and Central City Concern’s patient-centered medical home to connect participants with appropriate care and support. The navigator welcomes and orients participants, engages with them daily, coordinates resource support and medical services, and helps address acute needs and ongoing care. The position provides coverage for the primary staff member managing a caseload, responding to individual medical, behavioral health, and housing needs. This includes crisis management, referrals to treatment, help accessing benefits and entitlements, and support identifying suitable and affordable housing as part of a comprehensive approach to ending homelessness and supporting self-sufficiency. This is an on-call, variable-schedule position covering Monday through Sunday, with a strong preference for night-shift availability. The listed graveyard shift is 12:00 a.m. to 8:30 a.m. The position is based at Evergreen Crossing/Recuperative Care Building in Portland, Oregon. Compensation is $24.52–$31.88 per hour. Eligible overnight hours may receive a $1.75-per-hour shift differential, subject to the stated shift eligibility conditions.

Requirements

Education and experience sufficient to perform the responsibilities and demonstrate the described skills and abilities.
At least one year of experience working in a pre-hospital or post-hospital setting.
Current CPR certification before the start date.
Understanding of the causes of homelessness, the medical and psychosocial effects of homelessness, and the systems and processes used to help clients secure and maintain stable housing.
High tolerance for ambiguity and change.
Ability to relate to patients who are substance-affected, have acute mental health issues, or have poor hygiene.
Working knowledge of medical terminology.
Ability to be trained in the use of an Electronic Health Records system.
Non-violent de-escalation training, or willingness to complete it within 90 days of hire.
If driving, a current driver’s license, successful DMV background check, and designation as an acceptable driver under CCC’s Fleet Safety Policy; approved drivers must complete initial driver training within 60 days and ongoing recertification training.
Ability to carry and use an agency-provided cell phone for work.
Ability to comply with Central City Concern’s drug-free workplace policy.
Excellent reading and comprehension skills.
Availability to work weekends and/or holidays and on-call hours when necessary.
Ability to work efficiently in a very fast-paced environment.
Ability, generally with reasonable or no accommodation, to walk, bend, stoop, kneel, squat, twist, reach, pull, lift up to 50 pounds, and climb stairs.
Ability to pass a pre-employment drug screen, TB test, and background check, including DHS Background Check Unit clearance and eligibility to obtain an ID badge at partner hospitals.
Ability to follow agency nondiscrimination policies and interact respectfully with people of diverse ethnic, religious, political, and cultural backgrounds, lifestyles, and sexual orientations.
Ability to consider impacts and outcomes for underserved communities, including the effects of systems of oppression, structural racism, and individual bias on client outcomes.
Ability to function as a team member, remain flexible, and relate effectively to Recuperative Care patients.
Ability to address workplace conflict constructively.
Critical-thinking and problem-solving skills, including in emotionally challenging situations.
Good judgment and the ability to communicate clearly and concisely orally and in writing.
Ability to manage time, meet deadlines, and communicate courteously with the public, patients, medical personnel, corrections personnel, police, merchants, and coworkers.
Ability to develop and maintain positive working relationships with program staff, hospital partners, healthcare providers, and community resources.
Ability to maintain accurate records and paperwork, learn and apply training, and perform simple arithmetic computations.
Ability to maintain strict confidentiality of patient information.
Ability to maintain a calm, professional demeanor and make independent judgments.
Ability to transport patients in a company vehicle and handle emergency or violent situations with skill, confidence, and tact.

Nice To Haves

Bachelor’s degree in a healthcare-related field preferred.
Relevant lived experience is encouraged.
Experience in medical case management or care coordination, social work, counseling, behavioral health, other social services, emergency medical technician work, medical support staff, or nursing.

Responsibilities

Fill in for regular Recuperative Care staff based on program capacity, staffing, and task needs.
Coordinate patients’ acute and ongoing medical care under the program’s medical direction and in conjunction with Recuperative Care staff.
Serve as the primary point of contact for internal and external care coordination and resource linkage for assigned patients.
Help patients obtain prescribed medications and support plans for self-administration as prescribed.
Conduct welfare checks and document them for patients enrolled in the program.
Review hospital charts and internal medical records, and obtain patient releases to gather collateral information.
Create patient charts and update electronic medical records promptly with interactions, appointments, and encounters.
Participate in interdisciplinary case collaboration and regular caseload reviews with the RN Complex Care Manager.
Develop, implement, and maintain case plans for patients as needed, in collaboration with the interdisciplinary team.
Help patients coordinate with primary care, specialty medical, and other health service providers when concerns are raised or observed.
Identify, create, and implement behavioral interventions when appropriate, in conjunction with the interdisciplinary team and Integrative Care Manager.
Coordinate medical and behavioral health services as care plans develop and as directed through the medical support structure.
De-escalate heightened situations involving trauma, exacerbated mental health symptoms, and behavioral complexity.
Identify relevant housing or placement options and help patients overcome barriers to accessing them.
Collaborate with housing specialists and other available resources to support patients’ housing goals.
Follow Recuperative Care policies and procedures and apply trauma-informed care and harm-reduction principles.
Respond to emergency medical situations as needed and complete pre-hospital care and incident reports when necessary.
Provide or arrange transportation to program-related appointments, interviews, hospitals, and clinics; transport clients in a company vehicle only when approved as a CCC driver.
Screen patient referrals by phone or at partner hospitals.
Coordinate patient health care with primary care providers and specialty healthcare services alongside Recuperative Care and Central City Concern staff.
Attend clinical meetings and provide the team with current caseload information.
Participate in case reviews with the Recuperative Care team to support quality care and identify and address patients’ psychological, social, and medical needs.
Participate in compliance, quality assurance, and quality improvement activities as directed.
Comply with state and federal privacy regulations, including HIPAA and 42 CFR Part 2, and with agency and partner requirements for confidentiality, privacy, and security.
Immediately report breaches of protected health information or personal identification information to the CCC Compliance Department and the supervisor or designee.
Attend mandatory CCC trainings in a timely manner and perform other duties as assigned.
Supervise Recuperative Care volunteers when appropriate.