Program Patient Navigator

Works in the target community to engage and reach U.S.-born African American pregnant women, their partners, and families to mitigate the impact of historical racism on birth outcomes. Understands the health values, beliefs, and practices of the U.S.-born African American community; how the community accesses and interacts with the formal health care system; and cultural influences on help-seeking behaviors and attitudes toward health care providers. Navigates clients through the perinatal care continuum: screening, linkage to care, engagement in care, and retention in care; advocates on patient's behalf; assists patients to identify and mitigate barriers to accessing the perinatal care continuum. Serves as communicator and liaison between the patients/clients and the providers in the health care system.

This is a grant-funded position; the position is contingent upon renewed funding.

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

Patient Navigation / Case Management

• Screen U.S.-born African American women in Ramsey County for risk of low-birth-weight births, link those identified as at-risk to supports and services for high-risk pregnancies, and act as patient navigator for at-risk women engaged in perinatal treatment and care.
• Provide culturally appropriate 1:1 service to identify and reduce a client's barriers to accessing perinatal care services. Be a champion and advocate for each patient served.
• Liaise with clinicians, health educators, outreach workers, and key staff at target clinical and/or community sites to identify and screen at-risk U.S.-born African American women.
• Assess the psychosocial, behavioral, and economic needs of U.S.-born African American women of reproductive age at community sites in Ramsey County, link women to relevant internal and external services, resources, and programs.
• Navigate assigned patient caseload through accessing and adhering to needed perinatal supports and services. Coordinate patient referrals: schedule appointments, remind patients of upcoming appointments/tests using multiple communication modalities (phone, email, mail), troubleshoot access barriers to reduce no-show rates, educate patients on tests to be performed. Accompany empaneled patients to perinatal appointments.
• Assist with setting up and/or giving information for transportation for those with Insurance.
• Work with at-risk clients to identify "pillars of support" within their communities on whom they can rely throughout their pregnancies and after.
• Provide logistical support to project-supported DIVA Moms group prenatal sessions; attend all class sessions to assist lead facilitator(s) as necessary.
• Serve as primary point of contact for group prenatal care participants (e.g. drop-in DIVAs) between sessions. Ensure participants attend classes; remind participants of upcoming classes using multiple communication modalities (phone, email, mail); assist participants to troubleshoot barriers to attendance; monitor class attendance using attendance logs.
• Collect client data; maintain accurate patient registries; monitor data to assure timely client follow-up, as needed; track screening rates, referrals, services provided, and number of clients linked to care. Assist with program data collection, tracking, and reporting.
• Use evidence-based counseling techniques, such as motivational interviewing, to assist patients in healthcare decision-making and to elicit desired health behavior change.

Community Liaison

• Identify and recruit eligible women into the DIVA Moms program.
• Represent program at partner/community-based forums/events i.e. Tabling at Community events and others, as assigned.
• Ability to foster new relationships with community partners.

Key Competencies

• Technical Knowledge:Knowledge of and familiarity with principles of community health, health navigation, patient advocacy in a community-based service delivery environment.
• Relationship-Building: Skilled in establishing and maintaining effective relationships with vulnerable clients. Ability to establish positive working relationships with other health care professionals, the public, clients and staff.
• Cultural Understanding: Deep knowledge of, trust and respect in target population(s) served. Knowledgeable of the health values, beliefs, and practices of the U.S.-born African/American community.
• Initiative: Ability to take initiative to meet program objectives. Ability to approach daily workload and expectations with flexibility and self-direction. Capability to implement programmatic goals and objectives.

Supervisory Responsibilities

This position does not supervise any other staff.

Work Environment

Primary work environment will be the DIVA office. This role requires regular walking. This role may encounter patients who may have contagious illnesses.

Physical Demands

• Prolonged periods of sitting at a desk and working on a computer.
• Periodic standing, walking, bending, kneeling and stooping throughout the day
• Must be able to lift 15 pounds at times.

Position Type and Expected Hours

This is a flexible .75 FTE position. Normal work hours are 9:00 AM - 5:00 PM, Monday to Friday. This position requires regular, pre-scheduled evening and weekend work.

Travel Requirements

Must have the ability to travel between MCC and programmatic sites in the St. Paul/Minneapolis metro area and to other community-based service delivery sites in seven-county metro area.

Who We Are

As Minnesota's largest Federally Qualified Health Center, Minnesota Community Care ensures that the communities we serve have access to high quality and affordable health care. Our patients predominantly identify as people of color (80%), low-wealth (61% patients = 200% FPL), and un/under-insured (40% uninsured, 45% publicly insured) (UDS, 2020).

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. Minnesota Community Care values building a culturally diverse staff that reflects the communities it serves, and strongly encourages women, minorities, and persons with disabilities to apply. Minnesota Community Care is committed to providing Equal Employment Opportunities to all applicants. EO M/F/Disability/Vet Employer.

Required Education and Experience

• Minimum high school diploma or GED; equivalent combination of education and related training/experience may be considered
• 1-2 years of experience working directly with target population(s) in a community-based environment, preferably a community health center
• Valid Minnesota's driver's license, current proof of insurance, and consistent access to well-maintained personal vehicle

Preferred Education and Experience

• Certified community health worker, birth doula, perinatal educator, or other relevant community health/clinical certification

Additional Eligibility Requirements

• Demonstrated success in working effectively with target population(s).
• Change Agile; ability to operate in the gray and flex to new developments or situations.
• Experience working in a multi-site environment is highly desired.