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Community Health Advocate

2 months ago

Manchester, United Kingdom Boston Medical Center Full time
Job Summary

We are seeking a highly motivated and compassionate Community Wellness Advocate to join our team at Boston Medical Center. As a Community Wellness Advocate, you will play a critical role in helping high-risk patients maintain stable health and wellness by connecting them with hospital, home-based, and community-based services.

Key Responsibilities
  • Initiate face-to-face contact with eligible patients to describe the role, explain participation benefits, and begin the screening process.
  • Schedule and complete initial hospital, clinic, or community-based visits, care plans, and follow-up visits and phone calls for enrolled patients within specified timeframes.
  • Teach key educational messages using culturally, linguistically, and educationally appropriate strategies in various settings.
  • Clearly document all activities in the patient's record and care management system.
  • Participate in community outreach, presentations to community organizations, development of materials, and phone calls.
  • Work with patients and providers to set goals for patient care and provide guidance for patients to achieve those goals.
  • Reinforce educational messages regarding disease self-management by linking clients with supportive community services and programs.
  • Present patients at case review meetings succinctly and logically.
  • Consult with Patient Care Manager, primary clinical staff, behavioral health teams, and/or PCP regarding complex patient situations, demonstrating an understanding of how to solicit and incorporate provider feedback to continuously develop the most optimal plan for care.
  • Demonstrate the ability to function within an interdisciplinary team, connecting patients with resources as needed.
  • Record and monitor participants' progress toward goals within specific timeframes.
  • Document assessments and key patient updates in the Epic system; document relevant day-to-day activities and patient data.
  • Prepare reports and documents as needed or requested.
  • Assist patients with organizing their records, making follow-up appointments, attending follow-up appointments, and filling their prescriptions.
  • Help patients fill out applications for Medical Assistance, Housing, and SNAP (Supplemental Nutrition Assistance Program).
  • Provide advocacy, patient education, and successful warm hand-offs in accessing community-based and hospital-based programs.
  • Assist patients in addressing and overcoming barriers with a range of concrete supports, including healthcare support services, behavioral health, financial assistance, child-care and caregiver support, housing, support with utility bills, food, financial entitlements, clothing, transportation, food pantries, violence prevention, social isolation, and any other appropriate community resources.
  • Coordinate with community-based long-term services and supports.
  • Provide intensive home and community-based outreach, motivational interviewing, and goal setting, resource connection, and accompaniment to medical appointments as needed to help patients appropriately utilize healthcare.
  • CWAs may visit patients in hospital and ER settings to facilitate transitions of care.
  • Establish culturally appropriate and trusting relationships with patients and their families.
  • Participate in all training activities as designated by the Community Wellness Manager and the Nurse Practitioner.
  • Attend regularly scheduled supervision and other program-assigned meetings.
  • Develop and maintain strong relationships with the community and community resources to ensure patient access.
Requirements
  • HS Diploma with community experiences or Bachelor's degree.
  • Valid Driver's License and access to reliable transportation.
  • Minimum of 2 years prior healthcare, public health, or community-based experience in a community setting.
  • Basic knowledge of the healthcare system.
  • Outstanding interpersonal skills to interact with families and patients.
  • Interest in community health and outreach.
  • Exceptional organizational skills; ability to multi-task and work independently and as part of a team.
  • Demonstrated oral and written English communication skills.
  • Fluency in Haitian Creole or Spanish preferable.
  • Understanding of how language, culture, and socioeconomic circumstances affect health.
  • Desire to work with diverse, multi-cultural, and multi-lingual populations.
  • Proficiency with Microsoft Office applications (i.e., MS Word, Excel, Access, Outlook) and web browsers. Proficiency with data entry and data tracking.

Boston Medical Center is an Equal Opportunity Employer/Disabled/Veterans.