POSITION SUMMARY:

As a member of the integrated healthcare team, this role serves as a critical link between clinical services and community-based social support resources. The position is responsible for identifying patient needs across medical, behavioral health, dental, and financial or eligibility-related areas.
The role includes screening patients for psychosocial needs and social determinants of health (SDoH), assessing results, and connecting individuals to appropriate resources. This individual develops and maintains referral networks, navigates community services, and coordinates care to ensure patients successfully access and follow through with recommended support.

ESSENTIAL JOB FUNCTIONS:

• Complete screening tools and comprehensive assessments, including:
  • Psychosocial assessments
  • Social Determinants of Health screenings
• Collaborate with departments and staff to gather required patient documents and information
• Help patients obtain documents needed for:
  • Financial support
  • Continuity of care
  • HIPAA-compliant releases of information
• Work with patients to identify programs and services within the organization and community
• Make timely referrals to appropriate services to improve patient quality of life
• Assist patients with completing intake paperwork and ensure documentation is added to the chart
• Maintain patient privacy and confidentiality at all times
• For behavioral health patients:
  • Assist with transportation needs
  • Help reduce no-show rates through reminders and confirmations
  • Conduct comprehensive initial screenings for new behavioral health patients
  • Ensure urgent needs are addressed quickly
• Use the current EHR system to:
  • Document patient information accurately
  • Track referrals and follow-up
  • Ensure action is taken within appropriate time frames
• Perform other duties as assigned

• Bachelor’s degree required in:
  • Human Services
  • Social Work
  • Psychology
  • Related field
• Associate’s degree in a related field may be considered with comparable experience

• Knowledge of or ability to learn:
  • Electronic Health Records (EHR)
  • Patient engagement applications
• Proficiency in Microsoft Office Suite or similar software
• Strong critical thinking skills
• Ability to analyze complex information
• Strong verbal and written communication skills
• Ability to work effectively with individuals from diverse:
  • Socioeconomic backgrounds
  • Cultural backgrounds
  • Intellectual backgrounds
• Ability to work both independently and as part of a team

• Previous experience in:
  • Social services
  • Behavioral health
• 2–3 years of related experience preferred
• Bilingual in Spanish preferred

• This position does not have any direct reports.

• May require prolonged sitting
• Some bending, lifting, stooping, and stretching
• Normal hearing and vision required
• Eye-hand coordination and manual dexterity needed for office equipment
• May lift up to 35 pounds

LIMITATIONS AND DISCLAIMER:

The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.

All job requirements are subject to possible modification to reasonably accommodate individuals with disabilities. Some requirements may exclude individuals who pose a direct threat or significant risk to the health and safety of themselves or other employees.

This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position. Employees will be required to follow any other job-related requirements and to perform other job-related duties requested by East Central District Health Department/Good Neighbor Community Health Center in compliance with Federal and State Laws.

Requirements are representative of minimum levels of knowledge, skills and/or abilities. To perform this job successfully, the employee must possess the abilities or aptitudes to perform each duty proficiently. Continued employment remains on an “at-will” basis.

FTCA liability protection for medical malpractice is afforded to covered individuals by virtue of their working relationship with GNCHC, a FTCA covered entity when they are performing covered activities.

I have read and understand the duties and responsibilities for which I am responsible. The duties, responsibilities and minimum requirements have been reviewed with me and I have received a copy.