High Risk Navigator-Social Services - Nuvance Health

Description

Summary:

The High Risk Navigator-Social Services works to strengthen community partnerships to bridge healthcare and housing services, coordinate care and leverage resources. The Navigator works to improve outcomes by referring targeted individuals to appropriate community-based mental health and substance abuse services. Serves as a liaison to coordinate and leverage existing community-based resources to improve quality of care and patient engagement.

Responsibilities:

1. Convenes bi-monthly Coordinated Care Team meetings of representatives from community agencies including but not limited to local mental health authorities, hospitals, acute care facilities, federally qualified health centers, homeless outreach teams, substance abuse treatment facilities, city agencies and housing providers.
2. Provides liaison between local hospitals, outpatient clinics, emergency rooms, outreach teams, housing providers to better coordinate care for individuals whose care needs are complex.

3. Provides outreach as needed to Community Care Team referrals.

4. Brings together hospital inpatient and emergency room staff, outpatient care providers and housing providers in periodic case presentation meetings to identify duplication in services, leverage resources, coordinate care and outreach efforts and share aggregate outcome data.

5. Defines cross agency roles and solidify partnerships.

6. Serves as Community Care Team representative in local, regional and statewide meetings.

7. Establishes policies and protocols to expedite access to services as needed and set up mechanisms that ensure effective follow up.

8. Collects and manages data: Community Care Team patient reviews, care plans, demographics and outcomes.

9. Identify leaders, directors of care management or frequent use initiatives in hospitals who can broker high level partnerships bridging local government, social service providers, housing organizations, and hospitals.

10. Works with local implementation team to ensure program goals are being met.

11. Fulfills all compliance responsibilities related to the position.

12. Performs other duties as assigned.

Education: BACHELOR'S LVL DGRE

Other Information:

Required: Bachelor's degree. Bilingual (English/Spanish) required. Knowledge of health care fields and supportive housing required. Must possess strong leadership and communication skills, written and verbal. Excellent organizational skills are required. Ability to work well with multi-disciplinary service professionals. Good computer skills are required.
Minimum Experience: three years.

Desired: Masters degree in social services, health care, public administration or policy field preferred

Working Conditions:

Manual: Little or no manual skills/motor coord & finger dexterity

Occupational: Little or no potential for occupational risk

Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force

Physical Environment: Generally pleasant working conditions

Company: Western CT Health Network Inc

Org Unit: 681

Department: Community Health

Exempt: Yes

Salary Range: $27.91 - $51.83 Hourly