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Central Neighborhood Health Foundation seeks a Clinic Liaison to coordinate care for patients discharged from hospital settings. You will work with the ED team to ensure access to a medical home and optimize follow-up, addressing barriers and linking to community resources.
Responsibilities include coordinating discharge planning, scheduling follow-ups, and maintaining patient relationships while traveling to other CNHF sites as required.
If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.
SANTA FE SPRINGS, CA, US
Central Neighborhood Health Foundation is a Federally Qualified Healthcare Center (FQHC) committed to the Triple Aim as described by the Institute for Healthcare Improvement. Improving the US health care system requires simultaneous pursuit of three aims: 1) improving the experience of care, 2) improving the health of populations, and 3) reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an \"integrator\") that accepts responsibility for all three aims for that population.
The Clinic Liaison provides personalized coordination of healthcare services for patients discharged from the hospital Emergency Department and/or the inpatient setting. Once target patients are identified, the Clinic Liaison works collaboratively with patients, caregivers, and healthcare team members to ensure access to a medical home and optimize follow-up care. The Clinic Liaison develops and implements strategies to drive patient engagement, improve adherence with follow-up care, and decrease barriers to accessing care. This position is stationed directly at the assigned hospital Emergency Department.
This position will serve as the liaison between CNHF and Emergency Department and/or admitted patients of the assigned hospital
Facilitate access to services through assessment, coordination of care, and other care management activities. Work collaboratively with the care team to address the more complex needs of patients.
Work with the hospital team (nurses, care coordinators, discharge planners) to ensure patient health needs are met. This will include engaging patients, building rapport, and establishing trusting relationships with patients and their care teams
Assist patients discharged from higher levels of care with transitioning to a medical home. This may include scheduling a follow-up appointment with a CNHF provider, referral follow-up, and linkage to external services.
Engage patients and explain what services or resources are available
As available, obtain discharge paperwork and other relevant hospital records
Assist patients with barriers to care and care gaps. Identify, locate, and connect patients with medical and community-based resources to actively problem-solve and work towards solutions (i.e., arrange transportation, etc.)
Routinely outreaches to discharged patients to ensure appointments are kept
Attend regularly scheduled meetings
Travels to other sites as needed.
Performs other duties as identified or assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum 3-5 years’ experience in a clinic setting is required (preferably in an FQHC).
Minimum 1 year experience as a care coordinator, patient navigator or similar position
Knowledge of and experience with electronic medical records.
Excellent written and verbal communication skills required.
Ability to consistently make good decisions through a combination of analysis, wisdom, experience, and judgment.
Must be strongly detail-oriented and organized.
Must be very reliable and trustworthy in handling confidential information.
Must be efficient and effective with minimal supervision
Ability to multitask and prioritize workload in a fast-paced environment.
Ability to respond timely to changing demands.
Extensive experience managing patient issues.
Ability to establish and maintain effective working relationships with employees, patients, and the public.
Must have a valid California Driver’s License.
Described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Variations in conditions may occur under certain circumstances.
Maintains patient, employee, and Foundation confidentiality at all times, discussing patient or employee business only with appropriate parties who have a bona fide need to know; and communicating only the minimum amount of information necessary with respect to protected health information (PHI) as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).