New Participant Advocate

At Habitat Health, we envision a world where older adults experience an independent and joyful aging journey in the comfort of their homes, enabled by access to comprehensive health care. Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of All-Inclusive Care for the Elderly (“PACE”) in collaboration with our leading healthcare partners, including Kaiser Permanente. 

Habitat Health offers a fully integrated experience that brings more good days and a sense of belonging to participants and their caregivers. We build engaged, fulfilled care teams to deliver personalized care in our centers and in the home. And we support our partners with scalable solutions to meet the health care needs and costs of aging populations. 
 
Habitat Health is growing, and we’re looking for new team members who wish to join our mission of redefining aging in place. To learn more, visit https://www.habitathealth.com. 

Role Scope: 

We are looking for candidates who can ensure new PACE participants have a smooth transition into the program, immediately feeling a sense of belonging and caring.  Specifically, the New Participant Advocate seeks to understand a participant’s needs and expectations, ensures care continuity, develops a schedule that works for the participant, and introduces the participant and their needs to the rest of the care team.   

Key responsibilities: 

• Program Welcome - Assist with participant onboarding and orientation into the PACE program, serving as primary point of contact for first 30 days (or longer if necessary). Understand participant’s goals in joining the program. Conduct outreach calls or home visits to assess well-being and engagement. Encourage participation in activities, therapy, or support programs. 

• Participant Advocacy - Advocate for participant preferences and rights within the care team. Ensure participants receive culturally competent and person-centered care. Help identify and overcome barriers to accessing services. 

• Care Coordination Support - Help participants understand services at Habitat Health with partners (including Kaiser Permanente). Collaborates in scheduling medical appointments, transportation, and follow-ups. Coordinate with interdisciplinary team members as needed (doctors, nurses, social workers, etc.), ensuring continuity of care. 

• Communication Liaison - Serve as the main point of contact between new participants and the care team. Facilitate clear communication among participants, caregivers, and providers. Respond to new participants' questions, concerns, and needs promptly. 

• Documentation & Continuous Improvement - Maintain accurate records of participant interactions and support provided using our Electronic Health Record (Epic). Track participant progress, concerns, and follow-ups. Document social needs or care plan adjustments as needed. Identify and communicate trends in participant needs to center management, resulting in more effective marketing/enrollment strategies and improved processes. 

• Other duties as assigned 

Qualifications:  

• Strong organizational and communication skills 

• A minimum of one year working with the frail or elderly or case / client management 

• Aligns with our purpose and our values, and is excited about living those out in daily practice  

• Ability to work independently with influence 

• Proof of valid CA driver’s license, personal transportation, good driving record and auto insurance as required by State law. 

 

Nice to have: