CBCM Health Navigator

Job DescriptionJob Description Purpose: This is a full-time, grant-funded 35-hour/week position. Under the direction of the Associate Director, targeted Health Care Case Management is delivered that addresses all the domains of social determinants of health. This position is a direct service position supporting people in our public housing sites within Allegheny County toward self-sufficiency, housing stabilization and reduced risk of adverse health outcomes.

Essential Job Functions: Must be able to work independently, moving ACHA residents in the direction of independence by encouraging self-determination, and self-evaluation and consistently assisting ACHA residents to recognize their own strengths and using those strengths for personal growthMust demonstrate a strong work ethic and a high level of integrityProvide direct services to recipients within ACHA for the purpose of outreach, intake and assessment, education, and/or referral for identified Social Determinants of Health (SDOH) needsMaintain an active caseload of at least 40 individuals within the ACHA portfolioMust maintain confidentiality and provide information within agency guidelines and on a need-to-know basisProvide services in an empathic, hopeful, and welcoming mannerComplete all documentation and data collection in accordance to State and agency requirements including intake, assessments, data entry, and progress notesPrepare and maintain all necessary documents for the case file and insurance provider reporting.Provide education and linkage to Medical Assistance providers and support the development of living skills that will improve health outcomesEnhance coordination of services for behavioral and physical health with local Medicaid insurance providersEngage Community-Based Organizations as part of an integrated holistic approach to person-centered care and educationWork collaboratively with the CBCM Associate Director to identify interventions and resources available that increase Health literacy and reduce the risk of utilization of acute servicesDevelop and maintain a comprehensive list of local and state resources that address each domain of Social Determinants of Health, with a focus on street medicine, harm reduction and preventative screening best practicesFoster Cross-Departmental collaboration to help identify community-level needs and produce outcome deliverablesAbility to demonstrate time management, team collaboration, and professional written and verbal communication skillsAbility to demonstrate critical thinking and problem-solving to determine the best plan for each individual on their caseloadProvide quarterly and annual follow-up to ensure individuals served were satisfied with services and have maintained the resources providedCommunicate with other team members and program manager about resident progress and needsParticipate in scheduled supervisions to provide and accept feedback and identify opportunities for continued professional developmentDevelop individualized treatment plans with each resident to further develop their ability to live independently in the communityObtain Advanced First Aide and CPR certification within 6 months of employment Must have and maintain a valid PA driver’s license and use of a personal vehicle.Required Education/ Experience: Bachelor’s Degree in Social Work, Psychology, Nursing, OR no degree and minimum of 4 years of demonstrated relevant experience. Experience Preferred: Compiling and sorting date, entering raw date into database. Proficient in various programs to include, but not limited to: Microsoft Outlook, Word, and Excel.

Demonstrated knowledge and experience in the provision of community social services, insurance benefit navigation and continuum services of care. Physical Requirements: Work is performed both in office settings and community settings. Must be physically able to access various physical locations on and off ACHA.

Must have a level of manual dexterity sufficient to allow for the operation of a computer, telephone, fax machine, calculator, etc. Ability to move, handle or lift small objects around desk area, i.e. files, computer printouts, reports, calculator, office supplies, etc.