Health Coach/Community Health Worker Bilingual Chinese

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at20daysof paid time offand 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life andDisability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
• Interdisciplinary network of colleagues through the VNS Health Social Services Community ofProfessionals.

What You Will Do

• Reviews rosters to identify clients that require follow up and assistance.
• Provides a care plan to the client and care management team; notifies and assists of any immediate needs and risk factors and makes referrals to services to address such needs.
• Coaches members by providing motivational interviewing techniques and skills to address medical and psycho-social health. Motivates and supports client to participate in their individualized care plan.
• Provides outreach via phone to clients for a follow up on self-care, medication fills/refills, care plan engagement/adherence scheduled visits, and test results received from providers.
• Reinforces education provided by client's medical providers related to the management of the chronic disease or conditions specified in their care plan; helps educate clients about conditions and self care/condition management.
• Provides health coaching and support of assigned clients from initiation into program to completion.
• Works closely with the care management team to discuss clients' progress in plan and goals for completion.
• Provides information and assistance through advocacy and education to client/family on availability and eligibility of entitlements and community based services. Assists with client navigation of health system.
• Prepares detailed, accurate and timely case notes and utilizes care management platform as required to note client progress and updates.
• Works collaboratively with team members to provide outreach for and engage resistant clients with overdue screenings or upcoming appointments and /or who have been non-compliant with necessary treatment appointments.
• For CMO:
• Assists with general program support in areas of technology such as CarePort, Interactive Voice Response (IVR) Remote Patient Montiring andTiger Text.
• Assists in arranging clients who have been unresponsive to the care management team. May provide canvasing efforts to locate client.
• Assists clients in obtaining MD appointment.
• For Wellness Program:
• Uses motivational interviewing techniques and skills to identify substance use history and symptoms related to care plan.
• Provides guidance on self-management tools.
• Facilitates periodic case record reviews and case conferences with all providers serving the client. Reviews new cases for completeness of documentation.

Licenses and Certifications:

• License/Certification from a Community Health Organization required

Education:

• High School Diploma or equivalent required
• Associate's Degree in Human Services or related field preferred

Work Experience:

• Minimum of one year experience in care management, community health, social service, or
• medical practice preferred
• Basic computer skills preferred
• Effective oral/written/interpersonal communication skills required
• Bilingual skills may be required as determined by operational needs.