Accountable Health Communities Program Screener

Danbury Health Systems Danbury , CT 06811

Posted 1 month ago

About Nuvance Health

Nuvance Health is a family of award-winning nonprofit hospitals and healthcare professionals in the Hudson Valley and western Connecticut. Nuvance Health combines highly skilled physicians, state-of-the-art facilities and technology, and compassionate caregivers dedicated to providing quality care across a variety of clinical areas, including Cardiovascular, Neurosciences, Oncology, Orthopedics, and Primary Care.

Nuvance Health has a network of convenient hospital and outpatient locations - Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York - plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations. For more information about Nuvance Health, visit www.nuvancehealth.org.

Summary:

Under the supervision of the WCHN Site Director, the AHC Program Manager, and the site directors at partner sites, the Accountable Health Communities (AHC) screener will work at an AHC screening site and will be responsible for screening all AHC eligible patients/clients. This individual will assist appropriate patients/clients to complete the screening tool determining eligibility for referral to community services or referral plus navigation to community services.

Assist appropriate patients/clients to complete the screening tool determining eligibility for referral to community services, or referral plus navigation. The Screener supports providers and the AHC navigators through an integrated approach to care management and community outreach. The goal is to promote, maintain, and improve the health of patient/clients and their families through social support, informal counseling and advocacy for individual and community health needs. This position is regionally based.

Responsibilities:

1.Screen individuals for gaps in social determinants of health and provide them with appropriate referrals and connection to navigation services if indicated.

2.Provide and reinforce key educational messages in person.

3.Link patients/clients to supportive community services and programs, and assist in adopting healthy behaviors.

4.Assist patients/clients with completing applications and registration forms.

5.Promote CLAS (Culturally and Linguistically Appropriate Services) in an effort to advance health equity, improve quality and help eliminate health care disparities.

6.Identify and address barriers to care and work with patient/client teams to take advantage of all available community resources.

7.Work closely with medical providers, care coordinators, case management and AHC Navigators to help ensure patients/clients are screened and provided with resources.

8.Work cooperatively with other clinical personnel assigned to the same patient/client.

9.Attend regular staff meetings, trainings and other meetings as requested.



  1. Successfully manage assigned caseload of patients/clients.

  2. Develop a clear understanding of the experience, language, culture, and socioeconomic needs of the community.

  3. Develop a clear understanding of the social determinants of health-housing, food, utilities, transportation and interpersonal violence-and their importance in maintaining health and wellness.

  4. Conducts personnel interviews with clients/patients who are eligible for navigation services.


14.. Fulfills all compliance responsibilities related to the position.



  1. Performs other duties as assigned.

Other information:

Required: High school graduate or GED.

Must be proficient with computer systems, tablets and completing electronic forms. Must have the ability to exercise discretion and confidentiality in accordance with HIPAA in all formats, including verbal, written and electronic. Must have exceptional time management skills.

Must have excellent interpersonal and communication skills - relationship building/trust & honesty/compassion & empathy/respect & tolerance.Must possess the ability to be innovative and think creatively with regard to care of patients/clients and their families. Must have demonstrated ability to work both independently and as part of a team. Must have the ability to interpret basic data. Must pass a background check.

Minimum Experience: one year

Desired: Experience working in a community-based health/social service setting for at least 1-3 years.

Experience working in a multi-cultural setting. Have a solid knowledge of the community and its available resources. Bilingual/bicultural candidates are encouraged to apply.

Location: Danbury-24 Hospital Ave

Org Unit: 635

Department: CTCAPS AHC Grant

Work Type: Full-Time

Standard Hours: 40.00

FTE: 1.000000

Work Schedule: Day/Eve 10

Exempt from Overtime: Exempt: No

Education:

Essential:

  • HS Graduate or Equivalent

Working conditions:

Essential:

  • Significant manual skills / motor coord & finger dexterity

  • Little or no potential for occupational risk

  • Medium to Heavy effort. May exert up to 35 lbs. force

Western Connecticut Health Network and its affiliates are Section 501(c)(3) tax-exempt organizations and therefore eligible employees may qualify for forgiveness of certain federal student loans under the Public Service Loan Forgiveness Program.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Qualified Applicants are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other classification protected under applicable Federal, State or Local law.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.



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Accountable Health Communities Program Screener

Danbury Health Systems