Patient Navigator

Housing Works • New York, NY

7d • Hybrid

About The Position

The Patient Navigator will provide care coordination services to members with chronic health conditions. Patient Navigator will act as an intermediary between providers and members – serving in numerous roles such as educator, evaluator, service coordinator, community resource researcher and more. The Patient Navigator will assist in achieving fewer emergency room visits and hospitalizations, better coordination of services, and social service navigation.

Requirements

• Bachelors’ Degree in social work or related field with at least two years of experience in a related social service field
• Ability to make data entries into programs database such as AIRS, e-Share, EiCare
• Good group facilitation skills and overdose prevention training experience
• Skilled with health insurance navigation and documentation.
• Good verbal, written, communication and interpersonal skills.
• Use of computer software --Microsoft Office Suite including Word and Outlook calendaring, and Excel.
• Culturally aware and sensitive to PWUD (People Who Use Drugs), PLWHA (People Living with HIV/AIDS), LGBTQAI, YIDU (Young Intravenous Drug Users), SMI (Severe Mental Illness), and MSM (Men who have Sex with Men)
• Minimum of 2 years of experience of care management
• Experience working with the adult population
• Ability to travel to member’s residence
• Knowledge of community health and social service agencies, public benefits and additional community resources.

Nice To Haves

• Preferable training in the following areas: Motivational Interviewing Syringe Exchange and Harm Reduction HIV confidentiality and risk-reduction counseling Risk-reduction counseling HIV 101 Viral Hepatitis 101 LGBT Sensitivity Overdose Prevention Strategies
• Bilingual in Spanish/English helpful.

Responsibilities

• Provides case management services including but not limited to: Weekly and monthly progress summaries, quarterly assessments, quarterly care planning, counseling, outreach, case conferences, advocacy, Targeted Case Finding, Naloxone training/Education/Dispensation, referrals (on-site & off-site) and discharge planning.
• Completes initial assessment and quarterly reassessments on all assigned clients in a timely manner in-order to develop individualized treatment goals for each client.
• Establishes treatment goals and objectives with clients as part of the interdisciplinary team.
• Aid Case Manager in discussing, tracking appointments, documenting, educating and engaging clients in PREP/PEP, STI/STD and HIV treatment services.
• Ensure timely submission of clinical documentation to care organization for uninterrupted services.
• Facilitates harm reduction strategies support groups as needed.
• Assess client’s needs for services and cooperatively develop an integrated care plan and goals with the client, family, and other providers.
• Coordinate transitional care from inpatient service to other settings as per care plan.
• Work collaboratively with team members to provide outreach and engagement for hard-to-reach clients.
• Maintain documentation and update care plans at specific time intervals or as needed in Housing Works and Health Home electronic medical records system.
• Assists clients to navigate the health insurance system including the AIDS Drug Assistance Program (ADAP).
• Assist clients in navigation of internal and external medical systems
• Conduct field work to members’ homes and other provider settings as needed to fulfill plan of care
• Participate in regular case conferences, huddle meeting, and IDT as needed.
• Aid through advocacy and education to client and family for entitlements and other community services
• Understands and is sensitive to chronic medical conditions, including HIV, mental health and substance use, diabetes, asthma, hypertension, heart disease and hepatitis diseases
• Consistently exhibit Housing Works core values of teamwork, advocacy and customer service
• Connect with external organizations to identify life-saving resource networks for clients disconnected from services.
• Performs other duties as requested
• Participate in quality assurance and quality improvement planning project and activities
• Participates in monthly peer workers development meetings and interventions.

Benefits

• Three comprehensive healthcare plans to choose from based on your priorities and budget. Housing Works covers most of the plan; you pay a portion, based on your salary.
• Staff begins accruing PTO immediately for a total of up to 30 days earned in the first year.
• Educational benefit. This money is available for tuition loan reimbursement, tuition costs, and text books.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level