General Scope of the Job
The Emergency Department (ED) Diversion Community Health Specialist serves as a liaison for hospital patients (ED and admitted patients) in need of primary care and follow-up services after their discharge. Working with hospital staff, the Community Health Specialist reaches out to identified patients with pressing, complex and often unmet chronic care needs to ensure and facilitate their access to timely services appropriate to their health needs, including health insurance navigation and primary care with integrated mental health and substance use services.
Core Responsibilities
1. Engages with patients within the ED and high utilizers of ED services to determine their need for primary care services, as well as mental and social needs;
2. Facilitates establishment of new patients to Manet, assists with health insurance enrollment and schedules follow-up patient care appointments when indicated;
3. Represents the health center within the setting of the community hospital Emergency Department and hospital units, while maintaining high contact with health center supervisors and staff as indicated within the Manet Attleboro and Taunton locations:
4. Keeps informed of and utilizes supportive services and referral channels to ensure comprehensive, quality care for newly established patients;
5. Collaboratively works with operations and clinical teams to help encourage patients, family members and caretakers toward patient education and rehabilitation.
6. Assists selected patients with achieving health maintenance goals, chronic disease care, and navigation to social service agencies for psycho-social issues and connection to primary care. Engages in relationship building with patients.
7. As an embedded staffer, maintains the steady confidence of and collaboration with ED and hospital staff; observes the highest standards of patient confidentiality; and learns the electronic health record of both the health center and the community hospital partner.
8. Appropriately documents patient encounters and collaborates with the health center team, including operations and clinical care, and communicates patients’ needs when establishing their care.
9. Serves as a collaborator and access advocate–prioritizes health access and health equity.
10. Gives support for care plan compliance and proper use of the emergency department through educational strategies. Connects patients to health center, specialists, community and behavioral health and recovery resources, enabling, languages services and virtual-telehealth care as indicated to support goal setting and care plan.
11. Technology: Uses EMR and registries to create reports to direct improvement activities of teams and communicate progress to health center staff. Competence in EXCEL.
12. Performs other appropriate job duties as assigned.
Minimum Skills, Experience and Educational Requirements
• High School diploma or GED required. Associate’s degree preferred in Human Services or related
• Minimum 2 years of related work experience without a related Associate’s degree
• Excellent verbal and written communication skills.
• Experience with computer systems required, including web-based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.
• Bi/multi-lingual capacity preferred.
• Community Health Worker Certification is required and certification training will be provided for successful candidate if not already acquired.
• Previous experience in health care navigation, ambulatory care, community health centers, public health, emergency department, mental health or addiction services preferred.
Critical Demands of the Job
• Maintains professional composure and confidence during stressful situations.
• Communicates clearly and with good faith, anticipates circumstances and participates in problem solving process.
• Manage multiple requests and prioritize appropriately.
• Work within an emergency department and hospital setting as well as health center practice locations.
• Ability to function in a faced paced setting with a variety of patients and staff.
• Attention to details and prompt follow up.
• Includes walking and standing for periods of time, sitting for short periods of time, hand dexterity, clear hearing and speaking ability. Must be able to lift a maximum of 1/3 of their body weight.
• Excellent organizational, technological (telehealth, email, health record), and interpersonal skills.
Working Conditions
1. Works in well-lighted environment with comfortable surroundings.
2. Stressful at times due to competing demands and overlapping priorities, including attention to multiple patients and staff.
3. Includes walking and standing for long periods of time, sitting for short period of time, hand dexterity, clear hearing and speaking ability. Must be able to lift a maximum of 1/3 of their body weight.