Engagement Center Health Outreach Worker at Commonwealth Care Alliance in Springfield, Massachusetts

Job Description:

Why This Role is Important to Us

CCA's Engagement Center Health Outreach Worker (HOW) will provide patient navigation and support for patients with complex behavioral health and social needs. This person will report to the Engagement Center Director. The Engagement Center HOW will extend the CCA outpatient model of patient centered care management to a setting in the community and possibly in their home.

The HOW will focus on:

1) Providing patient assessments in the engagement center to help access their social determinants of health;

2) Conducting social needs assessments of patients, and then mapping discovered needs to appropriate resources in the community;

3) Building trust-based relationships with patients and their primary care provider;

4) Empowering and educating patients in group settings and in home to help in self-management of their behavioral health, social determents of health, and medical conditions;

5) Communicating primary outpatient care teams to ensure thoughtful care coordination and transitions;

6) Developing an expertise in caring for the complex behavioral health patients and how to connect them to their care coordinator or primary health provider.

7) Having the ability to provide minimal crisis management.

Supervision

The Engagement Center HOW is an essential component of the Engagement Center, helping the team to deliver high-quality, effective, and efficient care for CCA members that participate in the Engagement Center.

A successful candidate will be able to :

• Thrive in a fast-paced environment, is self-motivated and organized, has demonstrated ability to connect well and quickly with patients, and values impactful relationships with Members and fellow staff


• Exude passion for the HOW role, and is seeking more connecting to members in the community and in a center environment.


• Serve as a team a strong member of an interdisciplinary team of clinicians involved in patients' care


• Demonstrate empathy during patient encounters


• Set healthy limits and parameters to develop successful working relationships with patients


• The HOW will work in close collaboration with the Engagement Center CCA team, The HOW will also communicate regularly and work with each patient's outpatient care team and outpatient HOW to ensure care continuity.

All Locations
Main Street-Springfield




What You'll Be Doing

• Documents all clinical work in a timely manner and provides the necessary documentation


• Provides detailed sign out and information


• Attends clinical team meetings and other mandatory educational sessions


• Conduct needs assessment while patient is still in Engagement Center to evaluate potential for area of need.


• Help support an interdisciplinary team of clinical personnel (e.g., NP, BH, RN, etc.), managing the logistics of the Engagement Center.


• Ability to build longitudinal relationships with patients, making them feel comfortable and supported and ensuring basic needs are being met


• Participates in orienting and training new employees as required


• Participates in quality assessment and quality improvement within CCA


• Participates in CPR and NARCAN trainings.


• Attends external meetings and activities as a representative of the organization as requested


• Serve as liaison for the member's family, caregivers, or designated contacts


• Troubleshoot, conduct and support a social needs assessments, mapping, and navigation


• Oversee and manage a discharge checklist from a CSU or through member profile


• Conduct co-visits with BH clinicians, NPs, and other providers as needed,


• Travel between ED and patients' homes
  

What We're Looking For

• Associates' Degree or equivalent experience


• Bachelor's degree preferred


• 2 years of experience in community based outreach preferred * Associates Degree; BA in Human Services preferred years of direct experience in a healthcare or health plan environment, managed care preferred, with at least 6 years of experience in a leadership role or an equivalent


• Strong interpersonal and customer relations skills


• Effective teaching skills


• Ability to work with people from diverse backgrounds and experiences


• Knowledge regarding psychiatric rehab and understanding of recovery model


• Demonstrated computer literacy


• Ability to make visits in a home-based setting and access to reliable transportation


• Sufficient visual/hearing ability, with or without reasonable accommodation, to comprehend written/verbal communication and perform assessments of patients.

Actual Work Location
3550 Main Street, Springfield, Massachusetts 01107

Exempt / Not Exempt
Non-Exempt



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