Overview
Provides education, client advocacy, regular evaluation and feedback about clients on caseload. Assist with client's evaluation to determine their eligibility for other social service programs. Alerts team members when follow-up is required and ensures efficient and successful access and linkage to the full array of community based services with the goal of client's successful completion of the care plan. Works under close supervision.
Compensation Range:$15.79 - $19.73 Hourly
• Reviews rosters to identify clients that require follow up and assistance.
• Provides a care plan to the client and care management team; notifies and assists of any immediate needs and risk factors and makes referrals to services to address such needs.
• Coaches members by providing motivational interviewing techniques and skills to address medical and psycho-social health. Motivates and supports client to participate in their individualized care plan.
• Provides outreach via phone to clients for a follow up on self-care, medication fills/refills, care plan engagement/adherence scheduled visits, and test results received from providers.
• Reinforces education provided by client’s medical providers related to the management of the chronic disease or conditions specified in their care plan; helps educate clients about conditions and self care/condition management.
• Provides health coaching and support of assigned clients from initiation into program to completion.
Works closely with the care management team to discuss clients’ progress in plan and goals for completion.
• Provides information and assistance through advocacy and education to client/family on availability and eligibility of entitlements and community based services. Assists with client navigation of health system.
• Prepares detailed, accurate and timely case notes and utilizes care management platform as required to note client progress and updates.
• Works collaboratively with team members to provide outreach for and engage resistant clients with overdue screenings or upcoming appointments and /or who have been non-compliant with necessary treatment appointments.
• For CMO:
• Assists with general program support in areas of technology such as CarePort, Interactive Voice Response (IVR) Remote Patient Montiring andTiger Text.
• Assists in arranging clients who have been unresponsive to the care management team. May provide canvasing efforts to locate client.
• Assists clients in obtaining MD appointment.
• For Wellness Program:
• Uses motivational interviewing techniques and skills to identify substance use history and symptoms related to care plan.
• Provides guidance on self-management tools.
• Facilitates periodic case record reviews and case conferences with all providers serving the client. Reviews new cases for completeness of documentation.
• Participates in special projects and performs other duties as assigned.
Qualifications
Licenses and Certifications: License/Certification from a Community Health Organization required
Education: High School Diploma or equivalent required
Associate's Degree in Human Services or related field preferred
Work Experience: Minimum of one year experience in care management, community health, social service, or
medical practice preferred
Basic computer skills preferred
Effective oral/written/interpersonal communication skills required
Bilingual skills may be required as determined by operational needs.
About VNS Health
Curious to know what it’s like to work at VNS Health? We’re a diverse group. Our frontline team encompasses nurses, social workers, rehab therapists, physicians, nurse practitioners, and other clinical professionals as well as home health aides. We’ve learned that caring for people in their homes and communities is incredibly rewarding, and it provides a level of insight you rarely get in a hospital or office setting.
Our teams also include professional roles in finance, IT, marketing, human resources, business strategy, health plan services, and more. We’re aligned around a common mission, and we invite you to join us.
What Sets Us Apart
At VNS Health, you’ll have the opportunity to meaningfully impact lives. Including yours. We expect the best — and we recognize that we need to give our best too. That’s why we provide our team members with a comprehensive employment experience.
Our Values
Our three Core Values — empathy, integrity, and agility — guide everything we do. They’re what we bring to the table as individuals, as teams, and as an organization. They unify us around our common mission: To improve the health of people in need.
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Your Impact
VNS Health draws on a rich history and a legacy of trust to build a bright future. You can take pride in doing meaningful work that has the power to improve people’s health and change their lives.
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Your Career
Whether you’re a new graduate or looking for a leadership position, VNS Health provides the tools you need to be successful, from an onboarding buddy to opportunities for professional growth and training to grow your career.
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Your Total Rewards
VNS Health offers robust and affordable benefits to meet your needs. These include flexible paid time off, tuition reimbursement, adoption assistance, fertility benefits, and several programs designed to increase your wealth, like employer-matched retirement funds, as well as personal and financial wellness programs.
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