Engagement Navigator (Community Liaison Worker L II), IPA Project Operations *Temporary/Grant Funded*
New York, New York
Employer: NYC Health Hospitals
Industry: PROJECT OPS IPA
Salary: Competitive
Job type: Full-Time
Empower Every New Yorker - Without Exception - to Live the Healthiest Life Possible
NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city's five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible.
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.
Job Description
SUMMARY OF ESSENTIAL DUTIES AND RESPONSIBILITIES:
The Engagement Navigator will work under the direction of the Engagement Manager as a member of the Special Populations Care Management Program. The Engagement Navigator is an integral member of an interdisciplinary team within the emergency room (NYC Health + Hospitals Acute facilities) and community to provide outreach services that seek to establish a bridge to longitudinal forms of healthcare and care management. The team members utilize their interpersonal skills to develop a rapport with the patient during their stay in the emergency department and continue outreach to them after they leave the hospital through phone calls and fieldwork. The Engagement Navigator will support patients in feeling empowered and self-directed in their healthcare journey and bridge them to long-term care management resources.
The Engagement Navigator will be responsible for the following:
• Coordinate with the Engagement Manager to create a plan for reaching patients in the ED to address their immediate needs and assess potential care coordination opportunities.
• Work closely with the Engagement Manager to understand the patient's current community-based linkages to support patient re-engagement post-discharge, identify the gaps in healthcare linkages, and help them meet those needs.
• Complete an initial in-person engagement while a patient is in the ED to address the patient's immediate social needs. This may include offering goods and support such as food, clothing, and phone calls.
• Confirm the best method for follow-up contact (cellphone number, emergency contact, and field-based location for outreach).
• Support the patient in identifying and addressing their current needs to facilitate successful linkages to outpatient providers for primary care, behavioral health, substance use disorder (SUD), and specialists as needed.
• Within the electronic health record (EPIC), update contact information and note the best locations to reach the patient in the community to complete a follow-up outreach.
• Guide and/or accompany the patient to the pharmacy to obtain medication as needed post-discharge.
• Provide basic care management services with a harm reduction and trauma-informed lens while linking patients to long-term care model programs within the H+H system when appropriate.
• Develop and maintain professional relationships with healthcare providers in and out of the ED to best understand and coordinate efforts to meet patient needs.
• Maintain a caseload of actively engaged IPA-attributed patients with complex care needs post-ED discharge. The navigator will help address gaps in care post-discharge by scheduling appointments, providing reminders before the appointment, and supporting the patient with linkage for longitudinal care management.
• Complete outreach activities, such as diligent search activities, as required for IPA patients not actively engaged in treatment.
• Complete patient-centered referrals and linkages for non-IPA patients to existing resources and referrals.
• Conduct fieldwork to continue the patient relationship and bolster patient engagement with longitudinal healthcare resources as needed.
• Complete required documentation in a timely fashion to reflect patient engagement, outreach, provider collaterals, and case conferences. Complete preliminary screenings and treatment goals with objectives as outlined in accordance with programmatic requirements.
• Participate in quality assurance and quality improvement initiatives and activities as required.
• Facilitate linkage to community-based providers as needed.
• Ability to work during designated tours when scheduled including days, evenings and weekends.
• Provide accompaniment as needed.
• Perform other duties as required as a part of a multidisciplinary team.
Minimum Qualifications
For Appointment to Level I
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 community 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 above.
For Appointment to Level II
In addition to meeting the qualification requirements of Assignment Level I, appointment to Level II requires:
1. Two additional years of full-time experience in counseling, community work or community health activities in a government agency or community organization engaged in providing community services to the public, assisting members of the community in obtaining community services or maintaining liaison with schools, community organizations or other government agencies for the purpose of providing assistance and obtaining participation and support for implementation of community or public service programs; or
2. Education and/or experience equivalent to 1 above. Study at an accredited college in sociology, psychology or other behavioral science may be substituted on the basis of 30 semester credits for each year of the experience described above. However, all persons must have at least one year of the full-time experience described above.
Department Preferences
• Associate degree level with 2 years of full-time experience in direct care or Bachelor's degree with 1 year of full-time experience in direct care work.
• CASAC certification
• Prior experience assisting individuals with complex care needs such as individuals experiencing homelessness, criminal legal involvement, serious and persistent mental health diagnosis, substance use dependence and recovery, and intellectual or developmental disabilities.
• Prior experience with managed care, population health management, care management, Medicaid/Medicare populations and policies, health information technology, and/or provider network support preferred.
• Prior experience in working with PSYCKES, MAPP, EMEDNY, HARP, and HCS preferred; Redcap or other database development experience a plus
• Strong Microsoft Office suite skills (Word, PowerPoint, Excel, Outlook)
• Ability to conduct field visits (including street and shelters) and outreach activities within the assigned borough(s) of NYC.
• Ability to work nontraditional tours, please specify any exclusions for your schedule in your cover letter: work scheduled and varying tours as needed.
• Familiarity with harm reduction principles across settings (medical, substance use), and complex care principles (person-centered, equitable, cross-sector, team-based, data-driven)
• Familiarity with relevant electronic systems in the provision of human services supports (PSYCKES, CARES, CAIRS, Worker Connect and others).
• Excellent communication and documentation skills, including the ability to tailor communication style appropriately for various stakeholders.
• Excellent organization and attention to detail
• Solution-focused and resourceful
• Training in trauma-informed and harm reduction modalities such as motivational interviewing, Wellness Recovery Action Plan, Moral Reconation Therapy, Cognitive Behavioral Therapy, and Stages of Change.
• Knowledge of community-based resources within the New York City Metro area (including but not limited to entitlements and benefits).
• Proficiency in speaking a language other than English, preferably Spanish, Haitian Creole, Mandarin, Bengali, Russian, Cantonese, French, Arabic, Hindi, Urdu, Albanian, or Korean.
If applying online, please include your cover letter in the same file attachment with your uploaded resume.
NYC Health and Hospitals offers a competitive benefits package that includes:
NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city's five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible.
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.
Job Description
SUMMARY OF ESSENTIAL DUTIES AND RESPONSIBILITIES:
The Engagement Navigator will work under the direction of the Engagement Manager as a member of the Special Populations Care Management Program. The Engagement Navigator is an integral member of an interdisciplinary team within the emergency room (NYC Health + Hospitals Acute facilities) and community to provide outreach services that seek to establish a bridge to longitudinal forms of healthcare and care management. The team members utilize their interpersonal skills to develop a rapport with the patient during their stay in the emergency department and continue outreach to them after they leave the hospital through phone calls and fieldwork. The Engagement Navigator will support patients in feeling empowered and self-directed in their healthcare journey and bridge them to long-term care management resources.
The Engagement Navigator will be responsible for the following:
• Coordinate with the Engagement Manager to create a plan for reaching patients in the ED to address their immediate needs and assess potential care coordination opportunities.
• Work closely with the Engagement Manager to understand the patient's current community-based linkages to support patient re-engagement post-discharge, identify the gaps in healthcare linkages, and help them meet those needs.
• Complete an initial in-person engagement while a patient is in the ED to address the patient's immediate social needs. This may include offering goods and support such as food, clothing, and phone calls.
• Confirm the best method for follow-up contact (cellphone number, emergency contact, and field-based location for outreach).
• Support the patient in identifying and addressing their current needs to facilitate successful linkages to outpatient providers for primary care, behavioral health, substance use disorder (SUD), and specialists as needed.
• Within the electronic health record (EPIC), update contact information and note the best locations to reach the patient in the community to complete a follow-up outreach.
• Guide and/or accompany the patient to the pharmacy to obtain medication as needed post-discharge.
• Provide basic care management services with a harm reduction and trauma-informed lens while linking patients to long-term care model programs within the H+H system when appropriate.
• Develop and maintain professional relationships with healthcare providers in and out of the ED to best understand and coordinate efforts to meet patient needs.
• Maintain a caseload of actively engaged IPA-attributed patients with complex care needs post-ED discharge. The navigator will help address gaps in care post-discharge by scheduling appointments, providing reminders before the appointment, and supporting the patient with linkage for longitudinal care management.
• Complete outreach activities, such as diligent search activities, as required for IPA patients not actively engaged in treatment.
• Complete patient-centered referrals and linkages for non-IPA patients to existing resources and referrals.
• Conduct fieldwork to continue the patient relationship and bolster patient engagement with longitudinal healthcare resources as needed.
• Complete required documentation in a timely fashion to reflect patient engagement, outreach, provider collaterals, and case conferences. Complete preliminary screenings and treatment goals with objectives as outlined in accordance with programmatic requirements.
• Participate in quality assurance and quality improvement initiatives and activities as required.
• Facilitate linkage to community-based providers as needed.
• Ability to work during designated tours when scheduled including days, evenings and weekends.
• Provide accompaniment as needed.
• Perform other duties as required as a part of a multidisciplinary team.
Minimum Qualifications
For Appointment to Level I
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 community 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 above.
For Appointment to Level II
In addition to meeting the qualification requirements of Assignment Level I, appointment to Level II requires:
1. Two additional years of full-time experience in counseling, community work or community health activities in a government agency or community organization engaged in providing community services to the public, assisting members of the community in obtaining community services or maintaining liaison with schools, community organizations or other government agencies for the purpose of providing assistance and obtaining participation and support for implementation of community or public service programs; or
2. Education and/or experience equivalent to 1 above. Study at an accredited college in sociology, psychology or other behavioral science may be substituted on the basis of 30 semester credits for each year of the experience described above. However, all persons must have at least one year of the full-time experience described above.
Department Preferences
• Associate degree level with 2 years of full-time experience in direct care or Bachelor's degree with 1 year of full-time experience in direct care work.
• CASAC certification
• Prior experience assisting individuals with complex care needs such as individuals experiencing homelessness, criminal legal involvement, serious and persistent mental health diagnosis, substance use dependence and recovery, and intellectual or developmental disabilities.
• Prior experience with managed care, population health management, care management, Medicaid/Medicare populations and policies, health information technology, and/or provider network support preferred.
• Prior experience in working with PSYCKES, MAPP, EMEDNY, HARP, and HCS preferred; Redcap or other database development experience a plus
• Strong Microsoft Office suite skills (Word, PowerPoint, Excel, Outlook)
• Ability to conduct field visits (including street and shelters) and outreach activities within the assigned borough(s) of NYC.
• Ability to work nontraditional tours, please specify any exclusions for your schedule in your cover letter: work scheduled and varying tours as needed.
• Familiarity with harm reduction principles across settings (medical, substance use), and complex care principles (person-centered, equitable, cross-sector, team-based, data-driven)
• Familiarity with relevant electronic systems in the provision of human services supports (PSYCKES, CARES, CAIRS, Worker Connect and others).
• Excellent communication and documentation skills, including the ability to tailor communication style appropriately for various stakeholders.
• Excellent organization and attention to detail
• Solution-focused and resourceful
• Training in trauma-informed and harm reduction modalities such as motivational interviewing, Wellness Recovery Action Plan, Moral Reconation Therapy, Cognitive Behavioral Therapy, and Stages of Change.
• Knowledge of community-based resources within the New York City Metro area (including but not limited to entitlements and benefits).
• Proficiency in speaking a language other than English, preferably Spanish, Haitian Creole, Mandarin, Bengali, Russian, Cantonese, French, Arabic, Hindi, Urdu, Albanian, or Korean.
If applying online, please include your cover letter in the same file attachment with your uploaded resume.
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
Created: 2024-08-27
Reference: 110274
Country: United States
State: New York
City: New York
ZIP: 10036