Patient Navigator I/II

La Clínica de La Raza Inc.; Oakland (CA); On-site; USD 55,000 - 75,000; Full time

Job summary

La Clinica de La Raza is seeking a Patient Navigator to assess patients’ Social Drivers of Health and connect them with appropriate services. You will document SDH diagnoses in EPIC, perform data entry, and collaborate with the care team to coordinate resources.

Responsibilities include developing care plans, building partnerships with community providers, providing warm hand-offs, and following up on referrals to ensure needs are met, all while delivering culturally competent care.

Qualifications

• Experience with EPIC or similar case management systems.
• Knowledge of service coordination and navigation.
• Experience working with diverse populations and high-risk groups.

Responsibilities

• Assess Social Drivers of Health needs using screening tools.
• Develop care plans to meet patient needs.
• Connect patients with La Clinica services and community resources.
• Provide warm hand-off referrals to trusted resources.
• Enter SDH data into EPIC and maintain accurate records.
• Follow up on referrals to ensure needs are met.

Skills

Motivational Interviewing

Communication

Care coordination

Data entry

Time management

Advocacy

Education

Bachelor's degree in Health Education/Health Sciences or behavioral sciences

High School Diploma with 6 years relevant experience

Associates Degree with 4 years relevant experience

Tools

EPIC

Microsoft Office

Job description

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Who we are: La Clinica de La Raza is a non-profit, community-based health center established in 1971 to address health barriers and create better lives for the underserved. We have proudly grown into 35 sites across Alameda, Contra Costa, and Solano County. To learn more about our history, click here: Our History - La Clinica or visit our website at www.laclinica.org .

Job Summary:

We are seeking a Patient Navigator to assess and support patients regarding Social Drivers of Health (SDH). The role involves navigating and connecting patients to appropriate services within La Clinica and with government and community-based organizations to meet their identified needs. Responsibilities include entering SDH diagnoses and services into the EPIC system, performing data entry and reporting, and collaborating effectively with care team members.

Major Areas of Responsibility, include but are not limited to:

Duties/Responsibilities:

• Assess Social Drivers of Health Needs: Utilizing PRAPARE or an alternate screening tool required by the funding agency.
• Develop a care plan to meet patients’ needs.
• Acquire in-depth knowledge of La Clinica services to connect patients with the appropriate care options.
• Establish strong partnerships with community resource providers.
• Provide warm hand-off-referrals to trusted community resources.
• Conduct appropriate follow-up on referrals to ensure patients’ needs are fulfilled.
• Timely data entry into EPIC and other tracking systems.
• Provide culturally appropriate services.
• Provide patient care coordination and navigation.
• Provide coaching, social support and advocacy for patients’ needs both internally and externally.
• Utilize motivational interviewing to build patients’ capacity and confidence.
• Participate in evaluation process to assess patient outcomes and the impact of services rendered.
• Adherence to La Clinica’s all ethical and professional standards, including La Clinica’s policies and procedures.

Knowledge, Skills, and Abilities:

Knowledge

• Familiarity with various electronic systems, platforms, and evaluation methods.
• Understanding of Service Coordination and Navigation.
• Knowledge of community and governmental resources.
• Experience working with diverse groups and high-risk populations.
• Quick learner with the ability to retain complex information.

Skills

• Proficient in Microsoft Office.
• Proficient in Motivational Interviewing and Individual Capacity Building
• Strong communication and interpersonal skills with individuals from diverse backgrounds.
• Analytical skills to gather, analyze and interpret data for informed decisions.
• Well-organized and effective at managing time with the ability to meet tight deadlines.
• Strong problem-solving skills to identify, evaluate, and recommend solutions for complex issues.
• Strong critical thinking and sound judgement skills.
• Strong time management skills to effectively monitor patient caseload productivity in a timely manner.
• Skilled in advocacy, maintaining professional boundaries, and fostering effective communication with care teams, community organizations, patients, and providers.

Abilities

• Innovative mindset: ability to think outside the box, link disparate ideas, and develop original solutions.
• Resilient, adaptable, and detail oriented.
• Ability to work well independently and with others as needed.
• Ability to work effectively and collaboratively with customers including clinical and hospital personnel, administrative staff, health plans, patients, and providers, demonstrating emotional intelligence.
• Ability to advocate for patient needs and resources within La Clinica and external resources to ensure timely follow-up care.
• Ability to understand verbal and written language in English and specified language; specific language(s) to be determined based on location and organizational needs.

Education and Experience:

• Must hold a current BLS (Basic Life Support) Certificate. You will have 30-day grace period to obtain your certificate from the date of hire.
• Experience utilizing EPIC (preferred) or other case management program to document patient communication and care.
• Experience referring and linking patients to health care resources strongly preferred.Experience conducting In-Reach and Outreach strongly preferred.
• Experience must include providing peer counseling, support, education and/or advocacy services. Must be committed to supporting clients toward the goals of active participation in primary care as well as commitment to services that are strength based and focused on wellness.
• Patient care coordination experience strongly preferred.
• Requires a High-School degree/GED plus a minimum of one year experience providing patient navigation to underserved communities plus two years' work experience in a community setting, preferably at a health center.
• Requires Bachelor's degree in Health Education, Health Sciences or behavioral sciences with 2 years’ experience providing patient navigation/care coordination to underserved communities.

The Bachelor’s degree may be substituted with:

• High School Diploma or GED, and 6 years of relevant work experience.

OR

• Associates Degree, and 4 years of relevant work experience.

Preferred Trainings:

• Community Health Worker Certification
• Trauma Informed Care/Do No Harm/Motivational Interviewing/PRAPARE tool utilization
• Health Care Coverage and Enrollment or Certification

Physical Requirements:

• Remaining in a stationary position, often standing, or sitting for prolonged periods
• Bending/lifting, pushing/pulling, adjusting, or moving objects weighing up to 15 pounds in all directions and occasionally more.
• Repeating motions that may include the neck, wrists, hands and/or fingers.
• Upper extremity demands: Reaching above shoulder and/or below waist.