Lead Care Navigator at The Institute for Family Health

The Lead Care Navigator, in addition to providing patient care duties of Care Navigator, is responsible for mentoring and training Care Navigators in conjunction with the Care Management Coordinator, conducting ongoing chart audits to promote programmatic improvement and growth. Demonstrates initiative in developing data reports related to care management activities.

• Conducts community-based visits to patients and intensive community based outreach, as needed.
• Create ongoing training materials for new and senior Care Navigators in an effort to provide quality services to patients with the guidance of program associate and care management coordinator.
• Conduct administrative supervision with care navigators to provide supportive and ongoing feedback with the guidance of program supervisor
• Complete quality assurance activities under the guidance and supervision of care management coordinator
• Provides accurate, comprehensive health education literature to patients as necessary utilizing approved program materials.
• Works in close collaboration with physicians, mental health providers and other health care personnel in patient evaluations and treatment to further their understanding of significant factors affecting patient's health and adherence
• Refers to and/or provides case management services
• Tracks and follows-up with patients to ascertain compliance with scheduled appointments and treatment.
• Completes initial evaluations on all new patients within the first month of enrollment.
• Obtains patient consent to coordinate with all referrals and services.
• Actively utilizes quantitative measures to monitor patient progress such as A1C, PHQ9, blood pressure, and weight and documents progress in patient's record

• Attend patient's interdisciplinary planning meetings

• Assists with non- clinical evaluations (FACT GP, Comprehensive Assessment, PHQ 9, REALM, GAD 7, etc.)
• Assists in the collection of advance directives and documents them appropriately in the electronic health record.
• Conducts initial and periodic patient centered evaluations for care managed population

• Computer literacy with proficiency in MS Word, Excel, and PowerPoint
• Demonstrated organizational, interpersonal, oral and written communication skills and the ability to handle multiple assignments at any time
• Ability to generate, interpret and analyze data from multiple sources

EDUCATION

High school diploma or GED - Required

Bachelor's degree in social work, human services, psychology, nursing or related field - Preferred

At least one year of related experience - Preferred

COMPUTER PROFICIENCY

Basic computer and internet navigational skills - Required

Computer literacy with Windows-based operating systems and MS Office applications (Word, Excel, Outlook, Powerpoint) - Required

Familiarity with electronic health records (EHR) technology - Required

LINGUISTIC SKILLS

Bilingual (Spanish/English) - Preferred