Community Health Coach

US-WA-Lakewood
Req No.
2017-2271
Category
Clinical/Medical
Type
Regular Full-Time

Overview

ConcertoHealth Inc. is the leading provider of specialized primary care and supporting clinical services for complex, frail, elderly, and dual-eligible patients. Operating exclusively in value-based agreements, ConcertoHealth provides high-touch, individualized care for patients, and deploys wraparound clinical resources to extend the reach of primary care practices. This comprehensive medical management solution, elevated by Concerto’s proprietary population health technology, improves overall healthcare quality and patient outcomes, benefitting payers and their provider networks.

 

Concerto delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. The Concerto name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. Our approach focuses on bringing harmony across the spectrum of a patient’s care, health, and dignity.

The company is headquartered in Irvine, Ca. For more information, please visit: www.concertohealth.com

 

JOB SUMMARY

The Community Health Coach’s primary goal is to improve the health and outcomes of our patients. The Community Health Coach will be responsible for helping patients and their families navigate and access community services, other resources, and adopt healthy behaviors. The Community Health Coach supports our care teams through an integrated approach to care management and community outreach. As a priority, activity will promote, maintain, and improve the health of patients and their family, provide social support and informal counseling, advocate for individuals and community health needs. Community outreach, such as home visits and health screenings will be required.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Responsible for establishing trusting relationships with patients and their families while providing general support and encouragement.
  • Provide ongoing follow-up, basic motivational interviewing and goal setting with patients/families.
  • Develop, prepare, plan, and teach culturally appropriate health promotion and disease prevention materials to targeted populations utilizing medical standards and best practice.
  • Conduct intake interviews with patients, including enrolling and/or referring patients into Concerto and our health plan partners programs.
  • Follow-up with patients via phone calls, home visits and visits to other settings where patients can be found.
  • Assist patients with completing health plan applications and registration forms.
  • Conduct eligibility determination, enrollment and follow-up with uninsured patients.
  • Help patients set personal goals, and attend appointments.
  • Help facilitate referrals for services to community agencies as appropriate.
  • Help patients connect with transportation resources and give appointment reminders in special circumstances.
  • Maintain a current list of community agencies and resources.
  • Exhibit excellent working relations with patients, visitors and staff, effectively communicating ConcertoHealth’s mission.
  • Work closely with patient’s care team to help ensure that patients have comprehensive and coordinated care.
  • Follow-up with patients should be continuous from initial identification through closure.
  • Work cooperatively with other clinical personnel assigned to the same patient.
  • Be knowledgeable about community resources appropriate to needs of patients/families.
  • Act as a patient advocate and liaison between the patient/family and community service agencies (i.e. DSHS, Heath Care for Homeless, hospitals, support groups, etc.).
  • Record patient care management information in the EMR (training provided) and other software.
  • Attend regular staff meetings, trainings and other meetings as requested.
  • Manage assigned caseload of patients.
  • Other duties as assigned.

Qualifications

QUALIFICATIONS

  • High School Diploma or its equivalent. Associates Degree (AA) or Bachelor's Degree (B.A.) preferred in health/human services or related field.
  • Successful completion of a Community Health Worker formal training program such as from a college or other education institution is preferred.
  • Experience working in a multi-cultural setting.
  • Cultural sensitivity and ability to communicate effectively with individuals with varied cognitive abilities to establish relationships.
  • Experience working in a community-based setting for at least 1 to 2 years preferred.
  • Familiarity with medical terminology preferred.
  • Managed care experience preferred.
  • Basic computer skills.
  • Ability to initiate and maintain positive working relationships with ConcertoHealth staff and other organizations.
  • Understand the community served - community connectedness.
  • Good communication skills, such as listening well, and using language appropriately.
  • Ability and willingness to provide emotional support, encouragement and motivation to patients.
  • Ability to travel between care center areas.
  • Bilingual Preferred

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