Public Health Management Corporation

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Community Patient Navigator

at Public Health Management Corporation

Posted: 6/24/2019
Job Status: Full Time
Job Reference #: 9f17106b-91d0-405e-bf57-7c9bb032a41d
Keywords: patient, health

Job Description

The Community Patient Navigator (CPN) works with the Medical Home Community Team (MHCT). The MHCT will develop collaborative relationships with Philadelphia Department of Health, Division of Maternal, Child, and Family Heath and the Pennsylvania chapter of the American Academy of Pediatrics Medical Home Initiative to support existing medical homes to better meet the needs of children ages 0-21 and their families, work directly with families referred by these practices, and assist with recruitment and development of new medical homes in Philadelphia County. The CPN will be required to interface with medical practices, providers, and families of those practices frequently. The CPN will support the team’s efforts to build the capacity of medical homes by helping them to establish referral partnerships with community service providers, provide care coordination and home-visiting services to families with enrolled children, and providing some ongoing case management support. The CPN is responsible for health education, systems navigation, and collaboration with families, medical practices and social service providers. The CPN will conduct assessments and health screenings, observe behavioral health, communicate with clients and referral sources about child’s progress and health, and make appropriate referrals to community agencies and organizations for services not provided by the program. The CPN must be willing to work a flexible schedule including some evening hours, as requested.

Responsibilities:

  • Collaborates with medical homes staff/providers, advisory committees and referral sources to assess and determine most appropriate practices and resources.
  • Works closely with medical home staff/providers to build their capacity to effectively meet the needs of their consumers.
  • Builds and maintains strong relationships with community organizations, medical practice staff and parent advisory groups.
  • Provides care coordination services to families with the direction of medical home practices.
  • Develops and/or implements new approaches to improve program delivery, content, and/or evaluation to better serve the population.
  • Meets regularly with Program Manager to provide project updates and communicate project successes and anticipated barriers/challenges.
  • Provides updates and discusses barriers/challenges with project team members and partners at all scheduled meetings.
  • Conducts in-home activities, including screenings, health promotion activities and education.
  • Enters client data via web-based applications.
  • Attends regular grantee/partnership, state-wide and national meetings, as needed.
  • Monitors and maintains program materials and supplies to ensure adequate inventory for program needs
  • Works with Program Manager and team to complete all relevant reports.
  • Attends the required monthly Maternal, Child and Family Health meetings, and regularly attend the bi-monthly Philadelphia Special Needs Consortium meetings.
  • Keeps abreast of up-to-date work in the medical home field and shares information and resources with staff as appropriate.
  • Reviews and integrates new ideas and concepts with Program Manager and Assistant Director in order to improve project delivery, content, and/or evaluation for target audience.
  • Be trained and certified in Safe and Healthy Homes and SafeCare, an evidence based curriculum to prevent child abuse and medical neglect.

Health Education and Patient Navigation

  • Coordinates all aspects of family and individual health navigation and education.
  • Assists in the coordination of parent advisory meetings, including identifying sites, coordinating logistics, and completing appropriate reports.
  • Conducts follow-up with referral sources.
  • Provide education that includes a focus on parent-child interaction, home safety and medical wellness.
  • Assesses client and family needs and strengths with input from other team members (nurse, other case managers, program supervisor) and family members.
  • Schedules/coordinates patient/healthcare appointments, including: facilitating connection between patient and current primary care provider or linking patient to a new primary care provider; facilitating transportation to appointment, if needed; and accompanying patient to appointment, if needed.
  • Utilizes/Provides interpretation services during appointments, if needed.
  • Conducts appointment follow-up, if needed, including coordinating/scheduling follow-up services, and providing additional referrals for supportive services.

Skills:

  • Excellent understanding of the health system and community-based organizations in Philadelphia
  • Ability to establish priorities, and work both independently and in a team environment to meet objectives with minimal supervision.
  • Excellent problem solving, conflict resolution, time management and professional communication (written and oral) skills.
  • Excellent interpersonal skills and ability to effectively interface with partner organizations, families, parents, children and community residents.
  • Detail-oriented, with excellent organizational skills.
  • Proficient in Microsoft office suite.

Experience:

  • At least two years experience working with diverse populations, low-income individuals, individuals from different backgrounds
  • Minimum of three years of direct in-home, community-based and/or clinical services

Education Requirement:

  • Bachelor's degree in social work, public health, or a related field

Salary Grade:

  • Commensurate with education and experience