Care Specialist - Enhanced Care Management
- Santa Clara, CA
- Permanent
- Full-time
- At least 2 years of relevant work experience as a Community Health Worker, Peer Support Specialist, Medical Assistant, or in a similar role.
- High school diploma or GED required.
- A valid driver’s license and auto liability insurance.
- Reliable transportation and the ability to travel within assigned territory or as needed.
- Experience in care coordination for individuals with chronic conditions, behavioral health conditions, or with patients experiencing housing insecurities including homelessness.
- Strong interpersonal and motivational interviewing skills to build trust and rapport with patients.
- Familiarity with trauma-informed care, care coordination, and patient education.
- Proficiency in the use of electronic medical records (EMR) systems and basic computer skills.
- Technologically savvy and able to manage documentation and data entry effectively.
- Ability to work independently in a field-based environment and as part of a team.
- Multi-lingual capabilities preferred but not required.
- Prior home care or Enhanced Care Management experience a plus.
- Community Health Worker certification is a plus.
- Ability to work in dynamic, unstructured environments, pivoting quickly to meet the needs of patients and the organization.
- Demonstrates strong problem-solving skills when assessing patient needs and determining the best course of action.
- Uses motivational interviewing techniques to build rapport, set health goals, and empower patients to take charge of their care.
- Skilled in establishing trust and fostering strong relationships with patients, families, and team members.
- Takes initiative to perform outreach, complete assessments, and follow through with care coordination independently.
- Excellent at managing time, tasks, and schedules, ensuring that all patient needs are addressed in a timely manner.
- Demonstrates resilience in challenging situations and remains focused on the goal of improving patient outcomes despite setbacks.
- Demonstrates sensitivity to and understanding of diverse cultural backgrounds, ensuring that care is provided in a culturally inclusive manner.
- Shows passion for delivering high-quality care and support to patients, ensuring their well-being and satisfaction.
- Ability to assess patient needs, coordinate care with interdisciplinary teams, and ensure patients are receiving the appropriate services.
- Supports patients by navigating healthcare systems, advocating for needed resources, and ensuring timely access to care.
- Educates patients about their health conditions, treatments, and the healthcare system in a clear and empathetic manner.
- Proficient in documenting patient interactions and maintaining accurate, up-to-date records in EMR systems.
- Proactively reaches out to patients through multiple communication channels, including phone, in-person visits, and community outreach.
- Works with patients to develop self-care plans, emphasizing shared decision-making and increasing the patient’s ability to manage their own health.
- Works effectively as part of an interdisciplinary care team to achieve organizational goals and improve patient outcomes.
- Demonstrates flexibility and adaptability in managing unforeseen challenges, providing support where it is needed most.
- Skilled in using healthcare software applications and systems for accurate data entry and patient management.