Upham’s Corner Health Committee, Inc./dba/Upham’s Corner Health Center

Under the supervision of the Senior Manager of Population Health and Support Services the Population Health Community Advocate provides support and linkage to services, advocacy, education, and information in order to ensure optimal health outcomes, increase access of services, and support patients in self-management of health goals. The Advocate also serves as a cultural bridge to the health care system aiding in identifying and supporting the patients cultural identity.

Work Schedule

Monday to Friday: 8am-4pm

DUTIES:

• Work with the Population Health Coordinator
• Provides intensive case management services to patients who have recently been released from inpatient or ED visits
• Provides a cultural bridge between patients and the health care system
• Works within the Patient Centered Medical Home Model with primary care providers, Behavioral Health, home care providers, and other care team members to serve complex patients.
• Assists patients/family with identifying barriers and problem solve solutions and self-management skills.
• Participates in various UCHC committees to address the complex needs of patients
• Participates in work groups to pilot strategies to increase arrival rates
• Completes outreach to patients who are newly and chronically lost to follow up
• Works with Care Teams to assist people with new and chronic health illnesses such as Diabetes Mellitus, cardiac conditions, HIV, and others
• Participates with planned outreach/education activities in the community
• Identifies and help resolve potential/actual crises in collaboration with multidisciplinary team.
• Provides cross-cultural interpreter services and education for patients throughout the care continuum
• Conducts home visits after consultation with care teams and management.
• Documents patient/ collateral contacts in the EHR and maintain statistics.
• Participates in quality improvement projects within department and interdepartmentally as needed.
• Attends in-service trainings and outside seminars, as indicated.
• Performs other related duties as required.

Qualifications:

Bilingual in English/Spanish, English/Cape Verdean Creole, or English/Vietnamese

B.A or B.S in related field or three to five years' experience in health and human services

Excellent inter-personal, computer and writing skills as well as a desire to work in a helping profession with people in need

Evening and weekend flexibility