Care Team Lead - OH (Cincinnati)

#communityhealth #healthcare

About Us:

Cityblock Health is the first tech-driven provider for communities with complex needs—bringing better care to where it’s needed most, block by block. Founded in 2017 on the premise that “health is local” and based in Brooklyn, we are backed by Alphabet’s Sidewalk Labs along with some of the top healthcare investors in the country.

Our mission is to improve the health of underserved communities. Importantly, our solutions are designed specifically for Medicaid and lower-income Medicare beneficiaries, and we meet our members where they are, bringing care into the home and neighborhoods through our community-based care teams and Virtual Care offerings.

In close collaboration with community-based organizations, local providers, and leading health plans, we are reorganizing the health system to focus on what matters to our members. Equipped with world-class, custom care delivery technology, we deliver personalized primary care, behavioral health, and social services to deliver a radically better experience of care for every member and community we serve.

Over the next year, we’ll grow quickly to bring better care to many more members and their communities. To do this, we need people who, like us, believe that everyone should have good care for what matters to them, in their community. 

Our work is grounded in a belief in the power of a diverse community. To close gaps in care and advance equity in the communities we serve, we have to start with making our own team diverse and inclusive. Our ways of working are characterized by creativity, collaboration, and mutual learning that comes from bringing together a community from diverse backgrounds and perspectives. We strive to ensure that every person on the Cityblock team, and every Cityblock member, feels supported and included as a part of our community.

Our Values:

• Aim for Understanding
• Be All In
• Bring Your Whole Self
• Lean Into Discomfort
• Put Members First

About our Team: 

We employ a field-based, home-based care model and are committed to meeting members where they are--in their homes, in their community, and in our Hubs. You will go above and beyond to connect with Cityblock members in a non-judgmental, respectful and empathic manner, to meet their needs, and to provide feedback to the system as a whole as we strive to do better every day.

About the Role:

In this role, you will provide direct service to Cityblock members as part of our innovative care model, designed to address the complex health and social challenges of high-risk, high-need populations living in urban neighborhoods. It is integral to our care model that we meet people where they are, both physically and emotionally. Given this, your work will take you out into the community to provide care in settings that work best for our members.

Reporting to the Operations Director, you will lead the day to day functions of a care team made up of Community Health Partners (CHPs), Behavioral Health Specialists and Nurse Care Managers. You will support each of these team members in meeting their clinical, social and behavioral goals. You will work collaboratively with the supervisors of the Behavioral Health Specialists and Nurse Care Managers who will provide clinical oversight to those members of your pod.  You will provide coaching, support and supervision to our CHPs, a team that serves as the heartbeat of our care model. In managing and leading a team of CHPs, you will support and develop them as they outreach, engage and guide members through their Member Action Plans (MAPs).  

You will:

• Provide supervision and leadership for a team of Community Health Partners (CHPs), supporting them in meeting population level expectations.
• Lead the operations of an interdisciplinary care team, directly coordinating team time for each of the care team members.
• Provide guidance, coaching, and training around engagement, care planning, and longitudinal care.
• Support CHPs through their member outreach and engagement efforts. 
• Hold CHPs accountable for completing a comprehensive assessment of members’ health needs, including physical, behavioral and social.  
• From that assessment, support the development of member-driven, member-centered action plans that address social needs.  
• Model how to foster lasting and trusting relationships by doing so with your team and your members.  
• Act as a point person for the members on your team’s panels; co-visit members with CHPs, provide assistance in crises, etc.
• Support your team to work with members longitudinally to achieve their goals and identify new needs.
• Work daily within our custom-built care facilitation platform, Commo