1824 Madison Avenue
The Care Navigator will work as part of an interdisciplinary team to assist patients with chronic conditions in self-management support and engagement in the healthcare system. Care Navigators will ensure the execution of care plans by accompanying patients to medical appointments, promoting healthy living, buildings social supports, providing health education and promotion, and conducting home visits and community outreach. The Care Navigator will be expected to carry out pre-visit planning as well as provide case management to address patient’s individual needs as they pertain to treatment adherence (including, but not limited to, transportation to medical appointments, home health care, and insurance navigation).
• Work in close collaboration with physicians, mental health providers and other health care personnel to increase understanding of significant social and emotional factors underlying health problems for patients with chronic conditions and/or severe mental illness. Complete initial evaluations and comprehensive plans.
• Provide follow up support to patients through the development of care plans; utilize social and familial supports
• Conduct regular home visits and intensive community based outreach; Position is 50% clinic-based and 50% field outreach.
• Actively utilize quantitative measures to monitor patient progress such as A1C, PHQ9, blood pressure, weight and documents progress in patient’s record. Discuss and collaborate with patient and care team to improve measures and outcomes.
• Reinforce goals with patients and use care plan to monitor progress.
• Bachelor’s Degree in social work, human services, psychology, nursing or related field preferred
• Knowledge of social services field
• Ability to write professional reports and correspondence
• Ability to work independently and as part of a team
• Knowledge of health care field, particularly primary care and Medicaid
• Ability to identify resources and utilize problem solving skills in order to meet patient’s individual needs
• Excellent interpersonal skills
• Excellent time management and organizational skills
• Excellent computer skills required
• Bi-lingual Spanish preferred
This is an 1199 Union position- comprehensive benefits package is provided through the union.
Level of Language Proficiency
Bi-Lingual English/Spanish preferred but not required.
Minimum Education Required