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Care Manager - Health Educator II

Company: STRIDE COMMUNITY HEALTH CENTER
Location: Aurora
Posted on: November 26, 2022

Job Description:

Job DetailsJob LocationPeoria - Aurora, COSalary Range$23.93 - $25.97 In an aim to help keep our patients, staff, and communities safe, STRIDE requires that all hired employees be fully COVID-19 vaccinated and to obtain an annual flu shot. STRIDE CHC employees are also required to be screened for tuberculosis and to complete a PPD test.General Purpose: In order to support and help create positive health outcomes for patients, the Care Manager/Health Educator II provides pertinent and preventive health education, in-depth assessment, intervention, coaching, advanced care planning and support to STRIDE patients and their responsible parties to proactively manage their care. The Care Manager/Health Educator II is required to work with high risk and/or complex patients needing comprehensive Care Management and Health Education services to improve patients health outcomes.Essential Duties/Responsibilities:

  • Coordinates the delivery of health education and services to patients, including collaborating with clinical and other staff, to address patients needs in clinic/home/hospital settings as appropriate.
  • Provides appropriate health education to STRIDE patients in both group and individual settings as required, with a focus on STRIDEs patient education curriculum.
  • Participates in specialty clinics, group visits, and other, innovative, or novel modalities of care delivery for STRIDE patients.
  • Works collaboratively with clinic staff to implement and deliver education services to patients.
  • Participates in expanding and modifying models as needed for chronic conditions (e.g., pre-diabetes, diabetes, hypertension, etc.).
  • Participates in continually assessing health education effectiveness and adjust approaches accordingly.
  • Develops patient education materials and keep them updated based on latest practice guidelines.
  • Participates in continuing education activities at a minimum 1x/year.
  • Perform advanced needs assessment and care planning with high risk and/or complex patients providing in-depth education relating to chronic conditions.
  • Identifies patients risk factors leading to increased utilization and works with patients to reduce preventable hospitalizations, readmissions, and inappropriate utilization.
  • Coordinates and advocates for patients care in clinic/home/hospital etc.
  • Assess for Social Determinants of Health and provides support to address those barriers.
  • Assess patients psychosocial needs and develops care plans with patients and responsible parties to address issues.
  • Work closely with care team to help ensure patients have comprehensive and coordinated care.
  • Provides community resources appropriate to the patients/familys needs. Submits care management reports in a timely manner when required.
  • Provides timely documentation of assessments, goals, care plans, patients progress and other care management activities in EMR.
  • Responsible for evaluating and tracking patients progress, ensuring that coordination of care is being met.
  • Act as a patient advocate and liaison between patient/family and community service agencies (i.e. schools, Department of Human Services, home health agencies, specialists, hospitals, etc.)
  • Provides ongoing follow-up, advanced motivational interviewing, and goal setting with patients/families
  • Implements care plans through care coordination and interventions by referring, educating, negotiating, and mediating between patients and their providers.
  • Helps patients set personal goals and attend in-clinic appointments
  • Connects patients to resources within STRIDE and the community to address identified health concerns.
  • Maintains in-depth knowledge and educates members regarding various state plan benefits, programs, options, and services.
  • Help patients connect with transportation resources and give appointment reminders in special circumstances.
  • Participates in case review sessions as needed.
  • Provides input into the service delivery systems for Accountable Care within STRIDE. Service delivery systems include coordination of referral systems and interfacing with internal clinical and non-clinical services and programs.
  • Provides input into care management protocols and procedures based on evidence-based models
  • Provides mentoring and assists with skill building for entry-level care managers as needed.
  • Provides support and education to clients.
  • Visits home on an as needed basis for clients if they are unable to visit the clinic.
  • Determines appropriate service referrals, ensures services are received and monitors results.
  • Serves as liaison and advocate between clients, service systems and the community.
  • Research, prepares materials, and provides education as needed to clients
  • Research and provide guidance on outreach programs for a diverse population of at-risk clients
  • Attends all staff meetings and all other meetings as assigned.
  • Manage assigned caseload of patientsA successful candidate will possess the following education or formal training: Job QualificationsKnowledge, skill and ability:
    • Ability to interact positively and build rapport with patients, coworkers and/or external contacts.
    • Ability to respond to the needs and concerns of STRIDEs diverse patient population effectively and sensitively.
    • Strong verbal and written communication skills is essential.
    • Ability to handle sensitive information ethically and responsibly.
    • Ability to protect the confidentiality of patient, employee, and business information.
    • Ability to discern information from others in a variety of formats and communicate information to others in a manner that helps them understand instruction.
    • Ability to work independently in a manner that ensures accuracy and efficiency.
    • Ability to demonstrate empathy with potential cultural and diversity dynamics.
    • Knowledge of behavioral change theories and methods when providing care management and health education.
    • Time-Management and prioritization skills is essential.
    • Demonstrates advanced problem-solving skills.
    • Ability to utilize advanced customer service skills, including de-escalation techniques.Education or Formal Training: MSW degree, MPH degree, related Human Services or Dietetic field. Direct related Care manager/Case Manager experience may be substituted on a year-for-year basis for the masters degree. CHES preferred. Experience: Previous experience working in social work, behavioral health or public health required. Background in case management, health education, or community resources required.Material and equipment directly used: Computer, printer, multi-line telephone systems, fax machine, copy machine, calculator, and all Microsoft Office products including Outlook, Excel and the internet.Working environment/physical activities: Office environment within a clinical setting. Enters data into computer programs via computer, mouse and keyboard. Moves/transports objects up to 25 lbs frequently and up to 75 lbs occasionally to various locations throughout the metro area. Communicates information to others. Discerns/analyzes information from others to assist in decision making.We Offer:
      • Medical, Dental, and Optional Vision Insurance.
      • Paid-Time-Off (PTO).
      • Company Paid Life Insurance.
      • A 401K retirement savings plan & match!
      • Flexible Spending Account (FSA) and Dependent Care options. A successful candidate will live STRIDE ICARE values:
        • Integrity doing the right thing even when no one is watching.
        • Compassion meeting the patient where theyre at with empathy.
        • Accountability doing what we say were going to do.
        • Respect showing attention to human dignity.
        • Excellence having a growth mindset; striving to learn more and practice continuous improvement. Join Us. Together We Improve lives.STRIDE conducts a background check, including criminal history, education, license and certification.STRIDE recognizes and appreciates the rich array of talents and perspectives that equal employment and diversity can offer our organization. STRIDE is committed to making all employment decisions based on valid requirements. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the individual's race, creed, color, religion, gender, national origin or ancestry, age, mental or physical disability, sexual orientation, gender identity, genetic information or veteran status. STRIDE does not discriminate against any "qualified applicant with a disability" as defined under the Americans with Disabilities Act and will make reasonable accommodations, when they do not impose an undue hardship on the organization.

Keywords: STRIDE COMMUNITY HEALTH CENTER, Aurora , Care Manager - Health Educator II, Executive , Aurora, Colorado

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