Website SAC Health System
Provide outreach, care management and navigational services to a designated caseload of patients addressing community, social, and medical needs. Determine health concerns/gaps in care by assessing social determinant of health.
Work in collaboration with community agencies and build organizational relationships with community based organizations and programs. This position will serve as the liaison between SAC Health Systems and the surrounding community.
Facilitate access to services through assessment, coordination of care and other care management activities. Independently manage a caseload of patients requiring low to moderate medical and social needs. Work collaboratively with the care team to address more complex needs of patients.
Participate in Systematic Case Reviews. Present patient needs in a prioritized and organized manner and assist in developing a plan of care for patients based on integrated feedback.
Work within a team of nurses, behavioral health clinicians and care coordinators to ensure patient health needs are met. This will include engaging patients, building rapport and establishing trusting relationships with patients and their care teams. Cultivating strong patient relationships will be a cornerstone of this position.
Engage and enroll new patients into the program through in person or telephonic outreach. Work with team members to ensure team caseloads meet programmatic expectations. Gain a thorough understanding of program eligibility and expectations. Assist patients in maintaining eligibility to participate in the program.
Meet patients in clinics, in their homes or in the community. Accompany patients to medical or social support appointments. Work collaboratively with the care team to reduce barriers and increase access. Patient navigators will not transport patients
Education: High School Diploma or GED required. AA in Social Services, Social Work, Public Health, or Human Services preferred.
Licensure/Certification: Valid CA Driver’s License and liability car insurance required. Certificate as a Community Health Worker preferred.
Experience: Minimum of 1 year of experience as a community health worker, health advocate, community health navigator or community outreach worker. Medical Assistants with community based experience will also be considered. Bilingual Spanish/English. Knowledge of Medical Terminology preferred. Understanding of basic case management/care management principles preferred.
As a requirement of this position you must receive EPIC certification for the module you have been hired into.