Clinic Liaison in SANTA FE SPRINGS, California at Central Neighborhood Hlth Fdn

INTRODUCTION:

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.

SUMMARY:

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.

ESSENTIAL DUTIES AND RESPONSIBILITIES include but are not limited to the following functions:

• 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.

QUALIFICATION REQUIREMENTS:

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.

EDUCATION AND/OR EXPERIENCE:

• 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.

• Bilingual English/Spanish required

NECESSARY SKILLS:

• 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.

WORK ENVIRONMENT

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.

CONFIDENTIALITY

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).

1. AGREEMENT AND ACCEPTANCE

2. I HAVE READ THE ABOVE JOB DESCRIPTION AND FULLY UNDERSTAND THE REQUIREMENTS SET FORTH AND WILL PERFORM ALL DUTIES AND RESPONSIBILITIES TO THE BEST OF MY ABILITY.