Senior Patient Outreach Coordinator - Community Health Worker - Sickle Cell

Location: Atlanta, GA

Summary

At Marti Health, we advocate to eliminate health and social disparities for populations that have historically experienced barriers to optimal health, because we believe “injustice in health care is inhuman”.

We are a health services and digital health equity company passionate about improving the quality, consistency, and equity of well-being and health outcomes for socially disadvantaged patients and their caregivers. We're creating the gold standard for patient experience, compassionate care with dignity, and access to care and resources through our digital coordinated care hub. Our goal is to build and establish trust and improve health outcomes for a segment of the population that often feels overlooked by the healthcare system. We are creating value for individuals, caregivers, providers, health systems, and health service purchasers. We achieve this goal by building a value-based care model that uses community engagement to address gaps in care, and allocate social resources to address health inequities, starting with the sickle cell disease (SCD) community.

Purpose: Senior Patient Coordinators perform a wide variety of administrative, logistical, operational, and technical tasks related to customer care, caregiver, or health services programs in the specialized medical home. Duties shall include assisting with the implementation of health- centered programs by handling daily operations such as scheduling, training, conducting evaluations and overseeing programs and/or projects. Coordinators may serve as a liaison to other Marti Health care team members to coordinate Health Services programs, projects, or health related social needs services. They may work independently or as a member of a team. They work under general supervision, resolving most standard care coordination issues and referring complex issues to an upper-level manager.

The Marti Health Senior Coordinator and Community Health Worker will be responsible for assisting individuals and communities to adopt or adapt healthy behaviors as they pertain to SCD care. The position will be responsible for conducting patient, community, and organizational outreach for each site in the implementation of programs within the community that promote, maintain, and improve care for individuals with Sickle Cell Disease and increase awareness of Sickle Cell Trait status. The individual will also be responsible for providing social support and informal counseling, advocating for individuals and their community health needs. The CHW will additionally participate in data collection and quality improvement efforts.

Requirements

Primary Duties

• Provide or oversee intake services for all new clients and update existing client profiles within the care management system within 48 hours of an episode of care.
• Provide of oversee home-based customer evaluations as indicated
• Provide or oversee mandatory follow-up of clients within the Marti Health Specialized Medical Home case load to assure access to specialty and primary care (make all updates in system) and address barriers to their behavioral, psychosocial needs as well as health related social needs and factors driving adverse events and the status of their sickle cell disease outcomes.
• Provide assessment of all patients receiving care in Marti Health affiliated care centers to address barriers to optimal health and wellbeing.
• Input and manage outreach activities for affiliated providers where applicable.
• Follow-up with new member referrals to assess needs for services.
• Support Marti Health members individually in the inpatient and outpatient setting
• Intervene and refer members in a timely manner to appropriate resources/parties in patient care needs when challenges arise. Communicate with the Nurse Case Manager to address and resolve challenging and complex issues.
• Identify and catalog local resources and assistance programs for clients/patients and their families.
• Co-facilitate Sickle Cell Support Groups as needed
• Help organize, coordinate and implement Sickle Cell Disease Awareness events and celebrations as indicated
• Participate in community outreach and education efforts designed to educate the community about Sickle Cell Disease
• Develop consistent strategic direction and plans with management to execute outreach strategies to create maximum impact.
• Actively participate in site visits to ensure program adherence and capabilities.
• Manage tracking report for work completed
• Completing a detailed monthly report to deliver to management to accurately identify work accomplished through the month.

Additional Responsibilities:

• Coordinate, store, and organize supplies identified for transition program, Sickle Cell Disease awareness month, sickle cell groups, and other SCD-related activities (i.e., any education outreach and fundraisers with community-based organizations where appropriate)
• Provide support in all program areas as required.

Minimum Requirements:

• 2 years of experience in the community or as a volunteer or as a CHW preferred.
• High School Diploma and at least two years of higher education
• Excellent Communications Skills
• Excellent Organizational Skills
• Must pass or have passed a qualified CHW training program, attending the requisite training and field work.
• Ability to work with multiple stakeholders and consultants

Working conditions/Physical Requirements:

Work primarily in a climate-controlled environment with minimal safety/health hazard potential. This job will require up to 75% local travel.

At Marti Health, you will be part of a culture of care transformation and innovation, driven by a passion to tackle complex challenges facing the patients and their families, with respect, empathy, open-mindedness with a growth mindset. You will be part of a high-performing team willing to bring their range of experiences, interest, lived experience and values to their work- and who are all united by a shared passion for promoting health justice and a commitment to the Marti Health mission.

Marti Health is committed to upholding the principles of human rights and promoting fair labor practices in accordance with the United Nations Guiding Principles for Business and Human Rights (UN Guiding Principles) and the International Labor Organization’s Declaration on Fundamental Principles and Rights at Work (ILO Declaration).

Benefits

• Competitive salary plus equity plan
• Medical, dental & vision Insurance 
• PTO plan to encourage a healthy work - life balance
• A collaborative, entrepreneurial environment with a proven venture studio playbook
• The opportunity to create, build and grow innovative products with world class founders