Description

Company: Oak Street HealthTitle: Community Health Advocate (RBE)Location: Remote / Field-Based - Philadelphia or Detroit

 

Role DescriptionCommunity Health Advocates (CHAs) work one-on-one with high-risk patients to get to know them as people and help them do the things that they think will improve their health such as offering a listening ear, connecting them to resources like food delivery, navigating the health system, or working out with them at the YMCA. This is an autonomous position which requires a consistent drive for excellence, ability to make appropriate and timely decisions, listen with empathy, and use effective problem-solving skills. CHAs are responsible for thorough and accurate documentation and working collaboratively within a multidisciplinary care team.

 

Core ResponsibilitiesManage a caseload of patients and achieve established benchmarks for patient careMeet patients in their homes, at the hospitals or primary care clinic and conduct open-ended needs assessment to understand broadly what patients’ goals are for their healthUse motivational interviewing to help patients create person-centered action plans for reaching their health goals.Use of critical thinking to create goals for patient success based on both clinical and patient identified goalsProvide a wide variety of support (including emotional support, referral to community based resources, social services, clinical services, etc.) based on CHA discretion and available resourcesMake weekly contact (follow‐up calls and/or home visits) to patientsCoordinate and communicate with clinical care teams to provide relevant information about patient’s goals, clinical emergencies, and patients concerns, and to obtain medical information needed to inform CHA workCo-facilitate a weekly support group for patients, where applicable Work with other CHAs and staff to create a directory of community resources (e.g. food banks, housing assistance programs, childcare resources, etc.Attend interdisciplinary meetings with other medical professionals to align on readmission prevention planningExpertise in navigating Health Plan benefits and resourcingAccompaniment to specialist and provider visitsEstablishing and maintaining positive relationships with hospitals, PCPs, specialists and support staff to ensure seamless care coordinationPatient advocacy and support while navigating Social Determinants of HealthEfficient, quality and thorough documentation of patients enteractions including actions and goals of care to ensure effective communication among healthcare team membersNavigate patient enrollment within transitional program and manage referrals from other team membersForm relationships with and build an inventory of local community organizations Other duties, as assigned

What We’re Looking For

 

Degree Requirements and Minimum Experience Required:High School Diploma required.Long-time resident of assigned location and good knowledge of the resources of these communities.Comfortable with home visits and outreachPrior experience as an outreach worker a plus

 

Skill Requirements:Ability to exercise good judgment with patients, clinical care teams, others involved in the delivery of interventionsAbility to effectively manage time and tasks, prioritize, and stay organizedExcellent oral and written communication skillsExceptional active listening skillsProficient in MS Word and computer data entryUS work authorizationSomeone who embodies being “Oaky”

What does being Oaky look like?

 

Radiating positive energyAssuming good intentionsCreating an unmatched patient experienceDriving clinical excellenceTaking ownership and delivering resultsBeing relentlessly determined

 

Why Oak Street Health?

 

Oak Street Health is on a mission to rebuild healthcare as it should be, providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patient communities, and focused on the quality of care over volume of services. We are an organization on the move! With over 200+ locations and an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody Oaky values and passion for our mission.

 

Oak Street Health Benefits:  Mission-focused career impacting change and measurably improving health outcomes for medicare patientsPaid vacation, sick time, and investment/retirement 401K match optionsHealth insurance, vision, and dental benefitsOpportunities for leadership development and continuing education stipendsNew centers and flexible work environmentsOpportunities for high levels of responsibility and rapid advancement Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply. 

 

Learn more at www.oakstreethealth.com/diversity-equity-and-inclusion-at-oak-street-health