Healthcare Navigator

POSITION SUMMARY

The SSVF program assists Veterans who are homeless or at-risk of homelessness end their housing crisis. The goal of the SSVF Healthcare Navigator is to provide services that assist veterans in ending their housing crisis, enhance their independent living skills by providing supportive services and education, connect them with community resources, and empower them to maintain long-term housing stability and self-sufficiency.

RESPONSIBILITIES

• Connect Veterans to VA health care benefits or community health care services where Veterans are not eligible for VA care
• Provide health education
• Interdisciplinary collaboration
• Overall case management and care coordination
• Meet and set up appointments with Veteran and treatment team through virtual means/telehealth
• Act as a health coach by proactively supporting the Veteran to optimize treatment interventions and outcomes
• Perform assessments, develop/monitor case plans, and conduct necessary follow-up activities
• Establish linkages with appropriate agencies and service providers in the area/community
• Provide referrals and resources
• Educate participants on issues, such as supportive services available and participant rights
• Provide supportive services to participants
• Complete required documentation (including progress notes) within 48 hours of contact and enter data into the Homeless Management Information System (HMIS)
• Demonstrate good clinical judgement in decision making regarding participants
• Demonstrate ability to relate to Veterans and their families in a culturally competent manner
• Performance Quality Improvement (PQI) duties as assigned by supervision and PQI Committee
• Serve as a resource for education and support for Veterans and their families and helps identify appropriate and credible resources and support tailored to the needs and desires of the Veteran
• Participates in the development of the Veteran’s care plan with an emphasis on community services, outreach, and referrals needed for the Veteran
• Evaluates effectiveness of the resources and referrals provided and makes modifications to ensure provision of high-quality care and interventions
• Makes modifications to ensure provision of high-quality care and interventions
• Makes modifications to ensure provision of high-quality care and interventions
• Monitors Veteran’s progress, maintains comprehensive documentation, and provides information to treatment team members when appropriate
• Identifies concerns and/or questions about the Veteran’s treatment or medications and develops open communication with the provider or treatment team
• Collaborates with other providers in the ongoing reassessment of the Veteran’s health care needs
• Collaborates and regularly communicate with Veteran’s treatment team members to appropriately assess and address the needs of each Veteran
• Develop relationships with community partners, VA staff, and other referral networks
• Comply with all policies and procedures of the program and the Council on Accreditation

QUALIFICATIONS

• A Master of Social Work or a Master’s degree in a related field and less than five (5) years of work experience in the field; a person with a Bachelor of Social Work or a related undergraduate degree with more than five (5) years related work experience; a person with nine (9) years of experience in the field and no degree; or a veteran with six (6) years of experience in the field.