Commonwealth Care Alliance is a rapidly growing nonprofit organization providing integrated health care and social support services to people with complex medical needs. Our patients are seniors and persons with disabilities covered under Medicaid or both Medicaid and Medicare. Our innovative care model is nationally recognized for its effectiveness in improving health outcomes for these vulnerable populations.
Our unique care model is empowering for our employees as well as our members. Whether you are a clinical or administrative professional, all of us at Commonwealth Care Alliance receive the satisfaction of knowing our work truly makes a difference. We enjoy a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package.
The Health Outreach Worker works in collaboration with the primary nurse practitioner or physician assistant and other members of the care team to assist the person being served to achieve the goals outlined in the care plan. The Health Outreach Worker functions as an advocate and coach for members/patients who require additional support to address social, psychological and medical needs.
· Collaborates with the care team (nurse practitioners, behavioral health specialists, social workers, etc.) to support members; works with members to identify and achieve shared treatment goals
· Assists members to follow treatment recommendations, practice healthy behaviors and access necessary social and medical support services and programs (AA meetings, support groups, etc.)
· Links members with resources and empower them to use them to their advantage
· Uses recovery strategies such as motivational interviewing, harm reduction and strength based approaches to support members in attaining stated goals
· Conducts visits in the home or in other locations in the community, either alone or with other members of the care team to provide guidance, support, education and coaching. Follows up by telephone as necessary.
· Accompanies member to medical appointments as requested; facilitates effective navigation of the health care system
· Escorts member to pharmacy, grocery store, food pantry and other community locations as needed to meet care plan goals
· Arranges for translation services as needed and helps tailor information to literacy level on topics such as medication adherence, nutrition, exercise, fall prevention, home safety, substance abuse, advance directives
· Additional duties may include: checking/recording vital signs, teaching members to fill medication box, teaching members to prepare questions for doctor’s visit, transporting lab specimens to appropriate laboratory, participating in family meetings, participate in community outreach events
· Accurately document member encounters in medical record
· Participate in team meetings and communicate with members of the care team, proactively reporting changes or concerns and seeking guidance and support.
Minimum Education Required Associate's Degree or equivalent experience
Preferred_Educational_Experience Associates Degree; BA in Human Services preferred
Minimum Years Experience Required 2 years
Minimum Experience Two years of experience in community based outreach preferred
· Associates Degree; BA in Human Services preferred