Job Description
Overview
The Bedford-Stuyvesant Family Health Center (BSFHC) is a Federally Qualified Health Center (FQHC) that serves all primary health care needs of families in North and Central Brooklyn. Our mission is to provide professional, courteous, and high-quality health care with dignity to those we serve, especially the undeserved population, without regard for ability to pay. In addition to operating the Health Centers, we operate School-Based Health Centers to increase access to quality primary and preventive physical and mental health care for pre-school to secondary school students in high-risk areas of Bedford-Stuyvesant, Brooklyn.
NOT A REMOTE POSITION
Position Summary
Health Coach primary responsibility is to engage patients/participants in collaborative relationships, empowering them to manage their chronic diseases and environmental health to improve and maintain their well-being that leads to life-long healthy changes. This includes patient assessment for the Health Home At-Risk project and Health Home eligibility, care planning, facilitation of population health management, coordination of care for patients on caseload, patient education, patient advocacy, and regular evaluation of patients on caseload.
Responsibilities
Contact and perform initial interviews with individuals who are eligible for the health coaching program.
Provide coaching to reduce or eliminate behaviors that are high risk in participants with chronic diseases (e.g., Diabetes, Hypertension, Asthma and Hyperlipidemia).
Use registries to identify patients with newly diagnosed, undiagnosed or poorly controlled chronic conditions and schedule follow-up appointments.
Conduct outreach to patients with overdue screenings or upcoming appointments.
Perform intake and assessment of patients with newly diagnosed or poorly controlled chronic conditions, screen for Health Home eligibility, and check Health Home enrollment.
Screen for behavioral health and substance use problems, including depression (PHQ), alcohol abuse (AUDIT), substance abuse (DAST) and smoking status.
Reinforce education provided by PCP or nurse on management of the chronic disease, provide self-management tools, and review how to use those tools.
Establish goals and create a care plan; work with the patient to mitigate impacts of social factors on health and functional status (e.g., arranging transportation).
Conduct post-visit review of next steps with the patient.
Coordinate care, assist with referral management, and conduct between-visit monitoring and outreach.
Track and follow up on test results to ensure patient and caregiver take appropriate next steps.
Serve BSFHC's first point of contact during post-discharge care transition from hospital or emergency department.
Work with DSRIP Coordinator and practice's performance improvement team.
Assist in scheduling huddles and other internal team meetings.
Education/Experience Required
Certification from the National Board for Health and Wellness Coaches (NBHWC) required.
Strong background in nutrition preferred.
Minimum of 2 years’ experience as a health coach, including conducting one-on-one and group coaching.
Strong background in health promotion, chronic condition management, and behavior change methodologies.
Other Related Skills/Experience And Requirements
Must be flexible with scheduling
Maintain HIPAA patient/employee confidentiality
Knowledge of EMR systems a must
Bilingual ability a plus
Excellent interpersonal skills with professionalism, courteous and respectful attitude toward patients, team members, families and significant others
Display courtesy, tact and patience with all team members and the extended community
Ensure that all patients and visitors receive personalized prompt attention and are treated with receptiveness, dignity and respect
Provide instructions to the patient upon discharge as instructed by the providers
Strong organizational skills and ability to think clearly in a busy clinic
Strong skills in Microsoft Outlook and Word
Excellent verbal and written communication, and time management skills
Salary & Benefits
Salary Range: $25 per hour
Benefits Overview: We offer attractive compensation with comprehensive benefits including Profit Sharing Plan, Medical, 401(k), Long-Term Disability, Transportation Plan, generous paid vacations and holidays.
BSFHC is an Equal Opportunity Employer
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Job Tags
Hourly pay, Flexible hours,