Location Address:

Compensation Pay Range:

Summary:

Responsibilities:

• Coordinates and facilitates collaborative client care among the spectrum of available services both local and statewide in collaboration with the Director of Community of Community Based Programs
• Manages and Facilitates data collection, client files, fiscal record keeping and reporting to funders and other entities
• Connects clients with formal and informal community networks
• Fosters multidisciplinary collaboration and decision making with clients, providers and their families
• Compiles and maintains a working knowledge of a current list of available resources for referrals. Relationship building with state and local partners to assist persons in need
• Interacts effectively with customers, providing instruction and information, both written and verbal as appropriate
• Forms an alliance with PHS Community Health for collaboration, training and brain storming with leaders in the field
• Conducts health screenings, provides health education /coaching
• Assesses social determinants of health and addresses multiple issues simultaneously
• Identifies most critical needs of clients under the supervision of CBP Director and creates and manages action plans accordingly
• Implements, coordinates, and monitors strategies for patient and families to improve health and social outcomes. Functions as an advocate for client and family
• Advocate for and coach clients during interactions with various agencies when appropriate to ensure client¿s needs are being understood and met. Encourages client to
• assume responsibility for overall well-being.
• Documents all encounters, and contacts made on behalf of clients into appropriate database[s].
• Regularly reviews plan of action with client/ and supervisor and revises plan of action when
• appropriate.
• *Educates patients, families, providers, and care team regarding the role of the Families in Need Outreach Worker and strategies to address health related social needs.
• *Maintains confidential files and HIPAA compliancy.
• *Travels regularly to community locations, client residences, various agencies, and other outreach destinations.
   

Qualifications:

• High School/GED required
• Minimal of 2 years experience customer service work
• Bilingual Preferred

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services