The EIS Patient Services Navigator will function as a Sr. Community Outreach Specialist for the multifaceted clinical and research services of the Ryan White HIV/AIDS program in the John G. Bartlett Specialty Practice. The Patient Services Navigator will lead community and patient engagement and retention initiatives targeted toward people living with HIV, and people who are HIV negative and at high-risk for HIV. The incumbent will coordinate clinical linkage to care services within the Division of Infectious Diseases, Johns Hopkins Hospital and Johns Hopkins University inpatient and outpatient departments, the Specialty Division of the Johns Hopkins Outpatient Pharmacy, and any external organizations to support. Navigation of care will include a variety of clinical and research-based services in HIV/AIDS, focused on persons as at-risk for or living with HIV. The Patient Service Navigator will work in a fast-paced environment requiring exceptional organizational and interpersonal skills. The work may involve travel throughout Baltimore City and community-based organizations and clinics to assist with status neutral linkage to care services at the John. G. Bartlett Specialty Practice.
Duties and Responsibilities
Initiate, build and maintain professional relationships with patients in the clinic, offering support and guidance in medical and non-medical supportive services that are available in our program and in the community.
Provide advocacy, referral and linkage to community resources and support networks to address identified needs e.g., domestic violence, mental health, family issues etc.
Assist clients in navigating a complex medical system by building trust and a professional working relationship.
Work in collaboration with Early Intervention Services (EIS) Program Manager on developing HIV prevention, treatment, and health marketing materials.
Work with EIS Program Manager on developing and implementing outreach protocols.
Maintain all data tracking systems, including EMR (Electronic Medical Record), documents, spreadsheets, internal and external databases, and web-based systems
Act as a liaison between social work, clinic staff and patients as needed
Develop a referral process between John G. Bartlett Specialty Practice (JGBSP) and community partners.
Develop and implement training(s) for peer navigators and other staff as needed.
Encourage and support engagement activities for the JGBSP (creating and planning content for patient and community engagement)
Communicate any issues of concern (e.g., mental health concerns, substance use concerns, non-adherence) to patient care team.
Establish and maintain relationships with community partners by attending meetings, town halls and events.
Assess the patient's strengths as well as needs to address individual and community barriers to care and intervene as appropriate.
Assist with patient education groups in the John G. Bartlett Specialty Practice (JGBSP).
Conduct follow-up telephone and/or secure video calls with clients to ensure that services were obtained; reschedule appointments as needed.
Educate patients on self-advocacy skills and empower them to communicate effectively with their health care team
Encourage patients to use supportive services and counseling (e.g. substance use counseling, therapy, etc.)
Help coordinate and potentially accompany patients to medical appointments.
Help coordinate appointments via phone or secure video appointment.
Provide educational resource materials for patients and community organizations associated with coordinated care and supportive services
Provide navigation and linkage to care services for HIV treatment, HIV prevention (including PrEP) and supportive care services as needed.
Provide wellness phone calls and support to persons struggling with adherence and/or psychosocial issues (i.e. sexual orientation, gender identity, unemployment)
Assist with administration of annual patient satisfaction surveys
Plan and conduct client focus groups as needed.
Assist with tracking information and general record keeping
Maintain client confidentiality
Provide direct service to potential consumers and to those JGBSP consumers who have fallen out of care.
Document and provide pertinent information regarding services delivered in the EMR.
Build rapport with community-based agencies to streamline referral processes for housing, domestic violence support, legal services etc.
Attend and participate in regularly scheduled staff meetings and conference calls
Work closely with other program navigators to plan and conduct navigation and virtual outreach activities.
Participate in health promotion and health education outreach
Provide HIV testing and counseling services at JGBSP and community events
Any other duties at the discretion of the supervisor or manager of the project
Some related work experience
Additional education may substitute for required experience and additional related experience may substitute for required education, to the extent permitted by the JHU equivalency formula
1 year working with persons at considerable risk for HIV and/or living with HIV preferred
Excellent writing and interpersonal communication skills, particularly for communicating with a wide variety of individuals
Classified Title: Sr. Community Outreach Specialist Role/Level/Range: ACRO40/E/02/CD Starting Salary Range: Commensurate with experience Employee group: Full Time Schedule: M-F 8:30 - 5:00 Exempt Status: Non-Exempt Location: Hybrid/School of Medicine Campus Department name: SOM DOM Infectious Disease Personnel area: School of Medicine
The successful candidate(s) for this position will be subject to a pre-employment background check.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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