<p>Job Title: Social Care Navigator II</p> <p>FLSA: Hourly "Non-Exempt"</p> <p>Pay Scale: U-17 ($39.28/ $81,708.12 if annualized)</p> <p>Bilingual: Preferred</p> <p>Department: Mental and Behavioral Health</p> <p>Represented: Represented</p> <p>Reports to: Social Care Supervisor</p> <p>At Virginia Garcia Memorial Health Center, we honor all members of our community and acknowledge the dignity of each person we serve. Our purpose is to provide high quality, comprehensive primary health care to the communities of Washington and Yamhill counties with a special emphasis on migrant and seasonal farm workers and a view to removing barriers to health care. We strive to provide an environment that welcomes and values the people we employ and serve.</p> <p>If you are unsure whether you meet all the required qualifications for this role but are interested and passionate about this potential position, we encourage you to apply.</p> <p>Job Summary: The Social Care Navigator II functions as an integral part of the Integrated Behavioral Health Department's Primary Care integration providing consultation, conducting assessment and delivering individual counseling to better assess and address patient's needs as related to their resilience/self-determination, their ability to access outpatient services, and social determinations of health. This individual supports our population health initiatives through a behavioral health lens. This individual also provides skills training and case management services to patients that could benefit from community resources and care coordination that addresses their medical, mental health, and/or other psychosocial needs. The SCN II will collaborate with the Primary Care Teams to outreach and work with complex health and/or psychosocial needs of patients and those who are high utilizers of hospitals and Emergency department services. This position may supervise students in disciplines appropriate to the SCN II's educational background and qualifica[JB2.1][JB2.2]tions.</p> <p>Essential Duties and Responsibilities:</p> <ul> <li>Function as an integral part of the Integrated Behavioral Health Team attending huddles, team meetings and coordinating services with team members for complex patients. </li><li>May work with primary care medical teams, attending huddles and team meetings and connecting with team members as needed to assess patient's needs and connect them to resources in the medical and social services community. </li><li>Provide targeted evidence-based assessment and evaluations, which may include brief neuropsychological screens, diagnostic interviews, and impressions and functional status focused on the presenting problem. This can include assessing and justifying a complete DSM mental health diagnosis. </li><li>Develop treatment plans and provide ongoing outpatient mental health therapy. Conducts crisis interventions and safety planning. </li><li>Will provide a varied mix of mental health services and health and behavior interventions, depending on credentials and site. </li><li>Complete concise documentation in the electronic healthcare system of care and recommendations in the patient's medical record within 24 hours of seeing the patient. </li><li>Provides case management and gathers and maintains information, resources and accessible services of community agencies, local and state organizations, acting as a liaison with outside agencies. </li><li>Build a supportive relationship with patients to improve patients' utilization of necessary and appropriate primary care, mental health, and social services, to improve the patients' health status and health outcomes. </li><li>Use motivational interviewing to assess and positively affect the patient's level of engagement in their care and confidence in their ability to carry out a self-management plan. </li><li>Communicate with the primary care team, documenting all contacts with patients in the </li></ul> <p>EHR (EPIC) in a timely manner and communicate in person or by phone as needed.</p> <ul> <li>Provide culturally and clinically appropriate medical and mental health education and information to patients and coaches patients in making healthy lifestyle changes. </li><li>Act as the patient's advocate and health navigator, assisting them in understanding the most appropriate use of health care resources.[JB3.1][JB3.2] </li><li>Work with the Primary Care Teams and Integrated Behavioral Health to outreach patients with complex health and/or psychosocial needs and those who are high utilizers of hospital and Emergency Department services to remove barriers to care. </li><li>Provide work in the community with patients including home or hospital/ED visits and/or patient accompaniments to medical or social service appointments. </li><li>May facilitate, coordinate and organize group education or group provider visits, if approved by the supervisor and in consultation with the site management team. </li><li>Meets performance standards for productivity, documentation (including progress notes, assessments, treatment plans and authorization requests) proficiency in clinical model and evidence-based practices, quality of care (including engagement and retention) and teamwork as defined in the Performance Review </li><li>May supervise students in disciplines appropriate to the SCN II's educational background and qualifications. </li><li>Attend weekly supervision (internal or external) as required by licensure regulation. </li><li>Attend regular training as required. </li><li>Perform other duties as assigned. </li><li>Handle protected health information in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). </li></ul> <p>HIPAA Requirements:</p> <p>The Social Care Navigator II will have access to PHI in the course of their duties. The SCN II will use PHI to schedule patients, transport patients, and coordinate care for patients. Applying the minimum necessary standard of HIPAA, the designated record sets to which this employee will have access include the full medical record, the scheduling and demographic functions of the practice management system.</p> <p>Knowledge, Skills and Abilities Required:</p> <ul> <li>Bilingual/bicultural proficiency preferred. </li><li>Desire to work with underserved communities. </li><li>Desire to work with complex patients, including those who may be struggling with mental health and/or substance use. </li><li>Cultural competency. </li><li>Knowledge of methods of behavioral medicine and evidence-based treatments for medical, mental and behavioral health conditions. </li><li>Desire to provide short, goal centered counseling to eligible individuals. </li><li>Knowledge of how to address crisis situations. </li><li>High level of skill in interpersonal relations and problem solving. </li><li>High energy and self-directed individuals with excellent interpersonal, problem solving, organizational, and computer skills. </li><li>Ability to travel to clinics, home visits, and agency visits, etc. in a reliable, confidential, and timely manner.[JB4.1][JB4.2] </li><li>Ability to take initiative to proactively organize and manage the responsibilities of the job. </li><li>High degree in integrity and professionalism. </li><li>Good working knowledge of available social service resources or skills to acquire knowledge and information expeditiously. </li><li>Ability to work in challenging environments in the community at large and in patients' homes. </li><li>Ability to work as an integral part of a high functioning team. </li><li>Highly proficient with Microsoft Office applications (Word, Excel, PowerPoint, Outlook). </li><li>Excellent Customer Service skills. </li><li>Commitment and alignment to Virginia Garcia's mission, vision, and values. </li><li>Valid driver's license, reliable transportation, safe driving record, and insurance coverage required. </li></ul> <p>Education and Experience Required:</p> <ul> <li>Master's degree in a relevant field required; preferably in psychology, social work, human services or health-related field. </li><li>Registered or will register with the Board of licensees as an associate with a CSWA or LPC-A. </li><li>Meet criteria for QMHP in the state of Oregon. </li><li>Knowledge of therapeutic modalities and approaches </li><li>Demonstrated ability to conduct an assessment including identifying precipitating events, gathering histories of mental and physical health, alcohol and other drug use, past mental health services, and criminal justice contacts, assessing family, social and work relationships and conducting a mental status examination, complete a DSM diagnosis; write and supervise the implementation of an Individual Services and Support Plan and provide individual, family, and/or group therapy within the scope of their training. </li><li>Current CPR certification. </li><li>Experience with group facilitation. </li><li>Prior EMR experience preferred. </li></ul> <p>Behavioral Competencies:</p> <p>Accountability</p> <ul> <li>Role model VG's mission, vision, and shared values </li></ul> <p>Customer-Focus</p> <ul> <li>Listen to the voice of the customer and strive to delight them by exceeding their expectations </li></ul> <p>Teamwork</p> <ul> <li>If someone needs help, help them </li></ul> <p>Initiative</p> <ul> <li>Be innovative, apply fresh ideas, and continuously improve how you do your work </li></ul> <p>Confidentiality</p> <ul> <li>Maintain strict confidentiality and respect the privacy of others </li></ul> <p>Ethical</p> <ul> <li>Demonstrate integrity, honesty, and stewardship in all encounters at work </li></ul> <p>Respect</p> <ul> <li>Demonstrate consideration and appreciation for co-workers and patients </li></ul> <p>Communication</p> <ul> <li>Demonstrate the ability to convey thoughts and ideas as well as understand perspective of others </li></ul> <p>Physical Requirements:</p> <ul> <li>Percentage of time spent </li><li>Standing: up to 20% </li><li>Walking: 25% </li><li>Sitting: up to 50% </li><li>Reaching: 5% </li><li>Must be able to lift/carry up to 20 lbs.: infrequent 20-40 lbs. </li><li>Local travel: up to 75%[JB5.1] </li></ul> <p>Working Environment/Physical Hazards:</p> <ul> <li>Potential exposure to Blood Borne Pathogens. </li><li>Work environment includes working in patient's homes. </li></ul> <p>Equipment Used:</p> <ul> <li>May use Clinic Vehicles </li><li>Computer - data entry and word processing </li><li>Telephone, Fax, Copier, Printer, Scanner </li></ul> <p>Medical equipment:</p> <ul> <li>Pulse Oximeter </li><li>Glucometer </li></ul> <p>Immunization:</p> <p>Staff members must meet immunization requirements as stated in VGMHC's immunization policy and state and federal guidelines.</p> <p>Job descriptions represent a general outline of the essential and major job duties, functions and qualifications required. They cannot be all-inclusive and comprehensive due to the dynamic nature of work performed to accomplish VGMHC's Mission.</p> <p>VGMHC is an Equal Opportunity Employer. No person is unlawfully excluded from consideration for employment because of race, color, religious creed, national origin, ancestry, sex, age, veteran status, marital status, or physical challenges. The policy applies not only to recruitment and hiring practices, but also includes affirmative action in placement, promotion, transfer, rate of pay, and termination.</p>