Resource Navigator

OUTSIDE IN•Portland, OR

12h•$24 - $26•Onsite

About The Position

The Resource Navigator is a trusted member of the team who supports clients within primary care to navigate health and social service systems to improve overall health and wellbeing. The Resource Navigator is an integral part of the primary care team. They provide responsive, trauma informed outreach, engagement, health education, care coordination, advocacy, and system navigation services primarily for individuals experiencing homelessness, poverty, behavioral health concerns, substance use, and other social determinants of health.

Requirements

Understanding of issues involved in mental health, substance use, sex work, houselessness, diabetes, and particularly all other whole person health issues related to primary care.
Knowledge of trauma informed care, harm reduction and comfortable around non-abstinence-based programs and environments
Experience and interest in working in an interdisciplinary team setting
Proficient with Microsoft office Suite
Ability to learn and document within organizational electronic health record system
Ability to handle crises and multiple tasks in a setting with a high volume of patients.
Excellent communication skills
Flexible and adaptable in response to changing patient and health care providers’ needs
Commitment to the mission of care coordination
Passionate, trustworthy, and empathetic when working with patient
Able to assist in warm hand-offs, sometimes in person, from agency to agency and/or assist with appointments such as with the DMV, Tri-Met, etc.
Ability to work independently with timely follow through
Ability to complete all required documentation and information input in a professional, thorough, and timely manner
Ability to effectively navigate technologies used in this position including Epic OCHIN, MS Office Applications, and Windows Server
Ability to travel to various sites, outreach, community, and networking events
Ability to work with people from diverse backgrounds
Ability to provide timely, effective, and efficient customer service to the community, clients, and other employees
Ability to interact patiently with individuals making inquiries regarding various programs and services who may have little or no experience or knowledge of services provided
Ability to communicate and express ideas effectively both orally and in writing with co-workers and community partners
Time management skills, multitasking, and ability to work under pressure to meet deadlines
Ability to learn and perform health screening tests that require simple math
Ability to adhere to professional boundaries and ethics
Must adhere to Federal and State OSHA guidelines, including timely completion of mandatory trainings
Two years of relevant experience and competency working with unhoused populations, people with behavioral health concerns, and/or people with chronic health conditions, required
Credentialed as a Community Health Worker (CHW), required or within 6 weeks of hire
Knowledge of various health issues, conditions, and cultural health practices of communities served
Knowledge of healthy lifestyles and self-care strategies
Knowledge of behavioral health challenges and their connection to physical health
Knowledge of health behavior theories and basic public health principles
Knowledge of the health and social service systems common in the United States as well as community health agencies

Responsibilities

Conduct outreach to individuals in the clinic and community
Build trusting, non-judgmental relationships with clients using a trauma informed approach
Assist clients in accessing health care, behavioral health, housing, financial assistance, and community resources
Advocate for client needs with service providers while supporting client autonomy
Be an engaged team member of the Patient Centered Primary Care Medical Home care team
Interviews clients/patients to obtain basic data, past medical history, etc.
Implements individual and community assessment and treatment plans
Deliver culturally relevant health education on topics such as preventative care, chronic disease management, sexual health, mental wellness, and substance use
Support clients in understanding treatment plans, medication adherence, and self-management strategies
Promote health literacy and help clients navigate insurance, benefits, and community systems
Assist patients with paperwork and or referrals as needed
Assist with MyChart navigation
Assists in creating a positive and supportive work environment; enforces a safe workplace; establishes a culture of teamwork and communication; creates a workplace that promotes the organizational values and promotes an environment respectful of living and working in a multicultural society
Foster and maintain up to date relationships with community partners, resources, organizations, and opportunities to remove barriers and ease access to services
Follow up with patients who request resource assistance through the PRAPARE tool
Meet with patients for warm hand-offs after primary care physician appointments to review and update care plan with Panel Care Coordinator and Integrated Behavioral Health Counselors
Participate in daily huddles, case consultations, interdisciplinary care planning and team meetings
Communicate client updates, barriers, and successes to medical, behavioral health, and social service staff
Provide peer level insight into community needs and support care team decisions
Participate in process improvement projects pertaining to this role
When necessary, accompany patients to appointments
Maintain accurate, timely, and complete documentation of all patient encounters and complete reporting requirements according to organization standards
Track client contacts, referrals, outcomes, and care plans
Follow HIPAA, 42 CFR Part 2, and organizational compliance requirements
Follow up with patients when there are missed medical appointments and patient navigation sessions to initiate outreach and missed appointment procedures, as necessary.
Attend and represent the organization at in-service trainings, meetings, and professional conferences at the request of or with the approval of supervisor
Maintain strict confidentiality in accordance with agency policies
Other duties as assigned