Position Summary

This position is funded by a grant for a duration of time as defined by the grantor.

Under general supervision of the Community Health Access and Navigation in Tennessee (CHANT) program's leadership team, this person is primarily responsible for providing care coordination activities aimed at improving the health of the most vulnerable including TennCare eligible and TennCare enrolled pregnant women and children and youth under 21 years of age, including those with special health care needs.

Pay Grade: 48

Salary Commensurate with Experience and Education

Minimum Qualifications

100% -

1. Two (2) years experience in case management or care coordination experience; AND

2. Bachelor's degree from an accredited college or university in public health, business administration, business management, social work, sociology, psychology, public health, health administration, or closely related field; OR

3. An equivalent combination of related education and/or experience.

4. PROOF OF EDUCATION, TRAINING, AND/OR EXPERIENCE IS REQUIRED

Duties and Responsibilities

1. Informs, educates, and empowers the targeted underserved populations to improve health and wellness.

2. Prepares reports (i.e., daily activity reports, timesheets, and end of month and quarterly reports) in accordance with state/county guidelines, which includes using data reports to address findings from programmatic meetings/huddles.

3. Follows guidelines and mandates for children eligible for medical services.

4. Inputs data in State's and Health Department's databases.

5. Performs care coordination activities per CHANT mandates and grant deliverables.

6. Mobilizes and prioritizes relationships with organizations and community partners.

7. Plans, conducts, and participates in targeted community-based activities.

8. Develops effective internal/external communication to enhance outreach and education through social media, public service announcements (PSA) and other media outlets.

9. Participates in planning and implementation of targeted outreach activities.

10. Develops and implements an individualized plan of care/pathway for patients and maintains the medical records for these visits.

11. Develops plans to connect the families with the appropriate resources and services based on their needs and availability and provides appropriate follow-up.

12. Empowers families with information to become effective managers of their families' service needs.

13. Educates clients and families on importance of keeping appointments for well child checkups, well-women and immunizations requirements using key educational messages, including identifying appropriate referrals/resources based on the child/family needs.

14. Coordinates medical follow-up needs of family by telephone and mail correspondence to family and other community providers to promote continuum of care needs.

15. Receives assigned referrals from CHANT leader/supervisor and provides care coordination activities.

16. Assists CHANT families in navigation of care and goal settings per pathways of care.

17. Evaluates program services by providing feedback regarding program outcomes as needed at huddles/ staff meetings and uses data reports to address findings.

18. Makes home visits to investigate and validate client's needs and to promote care coordination and patient navigational activities.

19. Develops care coordination plans to connect families with the appropriate resources and services based on needs and availability and provides appropriate follow-up.

20. Follows Children's Special Services (CSS)/CHANT policy guidelines for children eligible for medical services.

21. Conducts screenings and assessments with individuals/families using the CHANT Screening and Assessment Questionnaire.

22. Visits clients or agencies to obtain necessary information to provide assistance to clients.

23. Attends in-services training programs and keeps abreast of current Maternal Child Health issues by seeking continuing education opportunities and participates in related continuing education activities.

24. Participates with Public Health Emergency Activities.

25. Performs other related duties as required or directed.

KSA's

KSAs -

1. Ability to use good judgment in evaluating situations and making decisions.

2. Ability to establish and maintain effective working relationships with clients.

3. Ability to apply analytical and problem-solving methods related to the assessment and quality assurance programmatic activities.

4. Excellent ability to have oral, written, and interpersonal communication skills.

5. Knowledge of health and social agencies and of community resources.

6. Knowledge and understanding of goals, purposes, policies, and practices of a best practice for care coordination, case management program.

7. Working knowledge of basic medical terminology.

8. Ability to demonstrated attention to detail and ability to be self-directed to work in a fast-paced professional environment with minimum supervision.

9. Proficient knowledge of Microsoft Office software (Word, Excel, and PowerPoint), databases and related software applications.

Physical Requirements

1. The physical activities of this position may include climbing, pushing, standing, walking, reaching, grasping, kneeling, ascending/descending stairs, stooping, and repetitive motion.

2. The physical requirements of this position are medium work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.

Special Requirements

1. Must possess a valid Tennessee driver license upon date of employment.

2. Must have daily access to an operable automobile and meet Shelby County requirements for automobile insurance upon date of employment.

3. Must be willing to carry a cellular phone.

4. Work will require attendance at field staff meetings.

5. Must be able to travel to locations outside of the office: home visitation, community agencies, schools, doctor offices, and secured correctional facilities.

Disclaimer

This position is subject to a background check for any convictions that have a substantial relationship to potential job duties. Only convictions that are substantially related to potential job duties will be considered and will not automatically disqualify the candidate.