Lincoln Medical and Mental Health Center is one of New York City's premier acute care hospitals. Located in Downtown Bronx, Lincoln is a teaching hospital renowned for its Centers of Excellence, and a recognized industry leader in the implementation of state-of-the art medical technology and best practices. Our team of highly trained and caring medical professionals is dedicated to providing the highest quality health care that is safe, compassionate, culturally competent and patient-centered. Comprehensive services are offered in three major primary care areas: Medicine, Pediatrics, and Women's Health in addition to more than eighty (80) specialty services. At Lincoln, the safety and comfort of our patients is our number one priority.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Visit us at www.nyc.gov/html/hhc/lincoln.

Job Description

PURPOSE OF POSITION:

Ensure safe transitions, eliminate barriers to care, ensure timely delivery of services, and decrease readmissions. Resulting in improved coordination of high-quality care, enhanced services for all populations, removal of barriers to care, more efficient delivery of care, improved outcomes, enhanced relationships with the community, and increased patient satisfaction.

DUTIES & RESPONSIBILITIES:

• Identifies patients for discharge and works on setting up concrete services - Performs patient outreach to address patient needs - Performs intake/assessment and follow-up as required
• Making referrals to Community agencies, rehabs (Acute,SAR,SNF) and homecare agencies. - Reactivating services for patients for discharge
• Ensure patient follow-up appointment with PCP (Lincoln and outside providers) as appropriate - Supports patients in need of assistance with one-on-one contact and assists Walk-in patients in the Department
• Ensures that patients with high-risk diagnoses receive the appropriate care based on best practices - Help the patients navigate through transitions in the health care system
• Works within the organization and through external services to eliminate barriers to healthcare
• Reaches out to patients to determine reasons for not keeping treatment appointments and/or arrangements as outlined in their discharge plan
• Collaborates with community agencies to provide new appointments and/or linkages for those patients who are non-compliant - Screen and Refer patients to Social Worker, when appropriate
• Collects data and submits report on activities/interventions and outcomes as identified
• Partner with Primary Care Physicians to coordinate and facilitate follow-up
• Participates in daily Huddles as required - Identifies with Social Workers, problem issues with community agencies and gaps in resources
• Reaches out to community agencies as representatives for the unit to explore new resources, problem-solve identified issues and/or develop linkages to facilitate patient referrals
• Incident reporting - Performs other duties assigned by supervisor as needed.

Minimum Qualifications
1. One year of full-time experience in a government agency or community organization in providing community services to the public or in assisting members of the community in obtaining services; or,
2. Completion of an approved six-month training program of combined classroom training and on-the-job experience in community liaison work, plus six months of full-time experience as described in (1).

If you wish to apply for this position, please apply online by clicking the "Apply Now" button or forward your resume, noting the above Job ID #, to:

Lincoln Medical & Mental Health Center
Human Resources Department
234 Eugenio Maria De Hostos Blvd, (East 149th Street),
2nd Floor, Annex
Bronx, NY 10451
Attn: Recruitment Unit

NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Loan Forgiveness Programs for eligible employees
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• College tuition discounts and professional development opportunities
• Multiple employee discounts programs