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Community Wellness Partners Care Navigator - ESSHI in New Hartford, New York

POSITION SUMMARY:

The Care Navigator conducts and schedules assessments, referrals, advocacy and supports, counseling, education of tenants in the ESSHI program. Acts as an advocate to be sure the tenant receives quality services to maintain optimum healthcare needs without barriers in an independent living setting.

ESSENTIAL RESPONSIBILITIES:

  • Greets new participant on arrival, attends lease signing, shows new ESSHI participant to their unit, provide basic tour of building.

  • Provides review of included services eligible to those enrolled in ESSHI program.

  • Completes Comprehensive Intake Form, HMIS Update, Media Release, Health Information Release, etc. after lease signing

  • Assist participant in identifying needs for unit to sustain in supportive housing.

  • Assist participant in getting settled in ESSHI unit.

  • Creates individualized care plan within 5 days of admission, update with significant change, and reassess annually.

  • Acts as liaison and works in conjunction with Presbyterian Residential Care Management Agency to make sure tenant makes monthly visit and completing any necessary requirements as directed by agency.

  • Conducts monthly meetings in person to review care plan and update as needed.

  • Assist with annual recertification for property/subsidy, Medicaid, SNAP, PNA, etc.

  • Ensures all initial linkages are established and maintained.

  • Collaborates with all service providers to include Community Care Managers, MLTC Providers, Aides, doctors’ offices, etc. and establishes team communication plan.

  • Attend doctor appointments as indicated by participant to assist with emotional support, ensuring all concerns are relayed, documentation to assist participant with follow up and understanding of provided information from physician.

  • Advocates for additional services and linkages as appropriate based on any observed or reported change in conditions.

  • Collaborates with all ESSHI team members for active involvement in ESSHI programing.

  • Attend team meetings.

  • Maintains daily documentation of all interactions with participants to include but not limited to text messages, phone conversations, appointments, service provider phone calls/emails, in person meetings, etc.

  • After hours on call rotation as designated by Program Manager.

  • Perform all other duties as outlined by the Program Manager/Director.

QUALIFICATIONS/EDUCATION/EXPERIENCE:

  • Bachelor’s degree in psychology, sociology, human services or related field. 1-2 years’ experience in Human Services, primarily Geriatric.

  • Basic Computer Skills (Windows, Outlook, Adobe Acrobat, Word, Excel).

  • This position does have regular and substantial unsupervised or unrestricted physical contact with individuals receiving services and is required by law to be fingerprinted for a criminal history record check.

  • Travel is required. Must have a valid NYS Driver’s License and clean drivers abstract.

  • Must possess the ability to make independent decisions when circumstances are warranted.

WORK ENVIRONMENT/HAZARDS:

  • Job related tasks do not involve exposure or potential exposure to blood, body fluids, or tissue and Category I tasks are not a condition of employment.

  • OSHA Exposure Category III

PHYSICAL DEMANDS:

  • The employee must have full sight and hearing with fluency in the English language. While performing the duties of this job, the employee is regularly required to talk or hear.

  • The employee frequently is required to stand, walk and sit. Must be able to sit for long periods of time.

  • Constantly operates a computer and other office productivity machinery, such as a copy machine, scanner, computer printer, etc.

  • The employee must occasionally lift and/or move up to 25 pounds.

  • Certain deadlines and unanticipated developments may require work during evenings & weekends.

  • The physical demands 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 individuals with disabilities to perform the essential functions of the position without compromising workflow and efficiency.

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