Position Status
Site
NHC Position Type
Position Summary
The NHC member will assume the responsibilities of a patient health care navigator. The NHC member will focus on tracking and acting as a patient navigator for patients who are identified as being part of a high-risk group: (1) patients with chronic medical conditions related to obesity (diabetes, hypertension and coronary artery disease), and (2) patients currently under addiction treatment or history of addiction and (3) patients in need of preventive health screenings.
Responsibilities will include:
- Keeping a population health registry for preventive care.
- Educating patients regarding needed preventive care screenings.
- Educating patients about self-management of diabetes, hypertension and coronary artery disease that focuses on life-style changes: diet, nutrition and exercise as well as appropriate tests and studies (i.e. eye exams).
- Healthcare navigation assistance for health center patients to ensure connection with the correct provider and follow-up.
- Creating and maintaining patient databases, resource listings with contact information.
- Creating and sending appointment reminders for patients that frequently miss scheduled PCP and specialist appointments.
- Attending weekly multidisciplinary team meetings to case manage challenging patient needs.
- Attending weekly MAT (Medication Assisted Treatment) team meetings set up to case manage our patients on various treatments for alcohol and opiate addiction.
- Attending monthly Integrated Behavioral Health team meetings.
- Evaluate and initiate appropriate referrals for assistance through County, State, and Federal programs when needed.
Major Duties and Responsibilities
Patient Navigator, Major Duties & Responsibilities:
- Assisting in care coordination and resource referrals.
- Tracking referrals and closing the referral loop.
- Evaluating referral charts and obtaining reports.
- Conducting outreach to patients via phone/letters.
- Linking patients to care by scheduling appointments.
Other Major Duties & Responsibilities:
- Brief health education to patients.
- Coordinating with other programs to provide health classes.
- Requesting medication refills for patients already enrolled.
- Attending meetings and patient huddles.
- Collaborating with leadership to meet needs of materials.
- Developing assessment tools to track patient improvement.
- Coordinating for resource distribution with other programs.
- Scheduling and coordinating communication for outreach visits.
- Assessing community data to locate areas that would benefit from community health screenings and referrals.
- Finding additional community resources and programs for patients.
- Coordinating patient care with the physicians through in-person or EHR communication.
Characteristics of an Ideal Candidate
Self-starter, Flexible, Multi-tasker; able to balance, Detail-oriented, Community Engagement/Outreach Skills.
Knowledge Required for the Position
- Knowledge of AmeriCorps/Health Corps member requirements.
- Skill with Microsoft Office or other software for a variety of data processing operations involving a range of problem solving, record keeping, correspondence, and service tracking options.
Supervision
Member uses initiative in carrying out recurring assignments following set procedures, and does so independently. The supervisor assigns service activities in terms of project objectives and basic priorities and is available for consultation in resolving controversial issues.
Review
The member independently plans and carries out the projects and selects the approaches and methods to be used in solving problems.
Guidelines
Detailed guidelines exist, including regulations and directives, handbooks, precedents, industry standards, and files of previous projects, Guidelines are generally applicable, but the member independently makes adaptations in dealing with problems and unusual situations.
Complexity
Member has to develop, analyze, or evaluate information before the service position can progress. In making decisions, the member is often required to depart from past approaches and extend traditional techniques.
Special Considerations
Personal vehicle required for this position.
Language Proficiency Requirements
Is proficiency in a language other than English required? No.
Criminal History Check Requirements Beyond NHC Standard Checks
In addition to NHC Standard Checks, all NHC Pittsburgh members are required to complete and pass criminal history checks for Great Lakes Behavioral Research Institute/Diversified Care Management (DCM). Great Lakes/DCM is a third party vendor contracted with the Allegheny County Health Department (operating site for NHC Pittsburgh) to distribute NHC Pittsburgh member stipends. NHC Pittsburgh members are onboarded to Great Lakes/DCM system only when the checks have been completed and the member has passed those checks. Along with these checks, some Host Sites require their NHC Pittsburgh Members to be Vaccinated against COVID-19.
The checks that all NHC Pittsburgh members would be required to complete and pass for Great Lakes/DCM are the following: 1) Act 33 (Pennsylvania Child Abuse Clearance), 2) National Sex Offender Registry Clearance, 3) Act 34 (Pennsylvania Criminal History Clearance, and 4) Act 73 (FBI Criminal History Clearance - ONLY completed via Identogo PA).
NHC members do not have to pay for the completion of these checks. Great Lakes/DCM will distribute payment codes for the Act 33 (Pennsylvania Child Abuse Clearance) and Act 73 (FBI Criminal History Clearance which is conducted through Identogo PA ( PA FBI fingerprinting agency). The National Sex Offender Registry Clearance and Act 34 (Pennsylvania Criminal History Clearance) will be completed by Great Lakes/DCM upon receiving requested information that members will be asked to submit.