Program Patient Navigator

 

Works in the target community to engage and reach U.S.-born African American pregnant women, their partners, and families to mitigate the impact of historical racism on birth outcomes. Understands the health values, beliefs, and practices of the U.S.-born African American community; how the community accesses and interacts with the formal health care system; and cultural influences on help-seeking behaviors and attitudes toward health care providers. Navigates clients through the perinatal care continuum: screening, linkage to care, engagement in care, and retention in care; advocates on patient’s behalf; assists patients to identify and mitigate barriers to accessing the perinatal care continuum. Serves as communicator and liaison between the patients/clients and the providers in the health care system.

 

This is a grant-funded position; the position is contingent upon renewed funding.

 

Essential Functions
Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

 

Patient Navigation / Case Management

• Screen U.S.-born African American women in Ramsey County for risk of low-birth-weight births, link those identified as at-risk to supports and services for high-risk pregnancies, and act as patient navigator for at-risk women engaged in perinatal treatment and care.
• Provide culturally appropriate 1:1 service to identify and reduce a client’s barriers to accessing perinatal care services. Be a champion and advocate for each patient served.
• Liaise with clinicians, health educators, outreach workers, and key staff at target clinical and/or community sites to identify and screen at-risk U.S.-born African American women.
• Assess the psychosocial, behavioral, and economic needs of U.S.-born African American women of reproductive age at community sites in Ramsey County, link women to relevant internal and external services, resources, and programs.
• Navigate assigned patient caseload through accessing and adhering to needed perinatal supports and services. Coordinate patient referrals: schedule appointments, remind patients of upcoming appointments/tests using multiple communication modalities (phone, email, mail), troubleshoot access barriers to reduce no-show rates, educate patients on tests to be performed. Accompany empaneled patients to perinatal appointments.
• Assist with setting up and/or giving information for transportation for those with Insurance.
• Work with at-risk clients to identify “pillars of support” within their communities on whom they can rely throughout their pregnancies and after.
• Provide logistical support to project-supported DIVA Moms group prenatal sessions; attend all class sessions to assist lead facilitator(s) as necessary.
• Serve as primary point of contact for group prenatal care participants (e.g. drop-in DIVAs) between sessions. Ensure participants attend classes; remind participants of upcoming classes using multiple communication modalities (phone, email, mail); assist participants to troubleshoot barriers to attendance; monitor class attendance using attendance logs.
• Collect client data; maintain accurate patient registries; monitor data to assure timely client follow-up, as needed; track screening rates, referrals, services provided, and number of clients linked to care. Assist with program data collection, tracking, and reporting.
• Use evidence-based counseling techniques, such as motivational interviewing, to assist patients in healthcare decision-making and to elicit desired health behavior change.

 

Community Liaison

• Identify and recruit eligible women into the DIVA Moms program.
• Represent program at partner/community-based forums/events i.e. Tabling at Community events and others, as assigned.
• Ability to foster new relationships with community partners.

 

Key Competencies

• Technical Knowledge: Knowledge of and familiarity with principles of community health, health navigation, patient advocacy in a community-based service delivery environment.
• Relationship-Building: Skilled in establishing and maintaining effective relationships with vulnerable clients. Ability to establish positive working relationships with other health care professionals, the public, clients and staff.