Responsible for outreach activities at assigned sites, working closely with medical providers, community-based organizations and state and federally funded healthcare insurance programs. Responsible for the enrollment of uninsured and underinsured populations in state and federally funded healthcare insurance programs and to promote continuity of care with selected primary care provider or medical home. The role of the case manager/CHW is to improve patient care and outcomes through coordination, health education and connections to appropriate care and services, benefits navigation and follow up. Direct street outreach and intensive case management may be required for at-risk populations. Reports to Associate Director of Case Management.
· Multi-lingual a plus (Spanish, Albanian, Portuguese, etc.)
· Ability to maintain confidentiality, adhere to HIPAA
· Ability to maintain accurate paper and digital records
· Knowledge of culturally diverse population
· Knowledge of large spectrum of community and social services in Waterbury area
· Any combination of 3 years health/social services experience and/or education
· Verifiable good driving record and reliable transportation.
· Basic computer skills
· Ability to work well cooperatively as a team as well as independently
· Flexible work attitude and ability to work with populations that have rapidly changing needs and urgent needs
· Approachable, compassionate demeanor, good listening skills
· Flexible work hours (may include some combination of evening and weekday hours)
· Associate Degree in health-related or social services curriculum preferred
· Knowledge of State and Federal health insurance programs desirable
· Community case management experience preferred
· Minimum of one-year related work experience
· Certified Community Health Worker preferred, on-the-job training provided
· Accepts referrals from hospitals, clinics, physicians, other healthcare providers, and community agencies to assess clients for individual GWHP program component eligibility and responds in a timely manner.
· Evaluate individual financial status and accurately complete and submit to Access Health CT and DSS, pharmacy assistance program (PAP) applications, and enrollment into Waterbury Project Access as applicable in a timely manner.
· Assist clients with the selection a primary care provider (PCP) or medical home within the community, schedule appointment for patient, document the outcome of referrals and assist with continuing recommended healthcare navigation.
· Evaluate needs of patient and make appropriate community referrals with the direction of the GWHP Clinical Case Manager/Supervisor and referring entity.
· Create patient record with responsibility for maintaining documentation of GWHP program activities in order to ensure accuracy of data for evaluative reports and compliance with grant requirements.
· Responsible for the inputting of patient information into a common database.
· Assists GWHP Clinical Case Manager/Supervisor in developing resource materials for patients
· Assists in developing creative outreach activities to target uninsured and underinsured adults.
· Attends events connected to program, participates in community activities to include occasional weekend events as needed.
· Help patients develop health management plans, goals and motivate patients to be active, engaged participants in their health
· Follow-up with health management/care plans with both patients and providers
· Coach patients in effective management of their chronic health conditions and self-care
· Assist patient in understanding care plans and instructions; health literacy
· Document activities, service plans, and results in an effective manner while strictly adhering to the policies and procedures in place
· Establish positive, supportive relationships with participants and conduct pre and post patient assessments per protocol
· Help clients in utilizing resources, including scheduling appointments, transportation and assisting with completion of applications for programs for which they may be eligible
· Assist clients in accessing health related services, including but not limited to: obtaining a medical home, providing instruction on appropriate use of the medical home, overcoming barriers to obtaining needed medical care and social services
· Facilitate communication and coordinate services between providers
· Effectively work with people (staff, clients, doctors, agencies, etc.) from diverse backgrounds in reducing cultural and socio-economic barriers between clients and institutions
· Conduct street outreach for clients with intense cases as necessary
· Continuously expand knowledge and understanding of community resources, services and programs provided; human relations and the procedures used in dealing with the public as part of a service or program; volunteer resources and the practices associated with using volunteers, operations, functions, policies and procedures associated with the department or program area, procedures and resources available to handle new, unusual or different situations
· Other duties as assigned
Job Type: Full-time
How to Apply
StayWell Health Center