Hep C Care Coordinator

Linkage

• Ensure individuals who screen preliminary positive for hepatitis C are linked to medical care and receive confirmatory testing.
• Provide intake to medical care including opening charts in the EMR, completing releases, assessing barriers to linkage and retention, coordinating records requests, and scheduling appointments.
• Accept and coordinate internal and external referrals for hepatitis C management.
• Orient patients to available services within Trillium Health and to the organization’s mission.

Patient Education

• Meet with all hepatitis C patients prior to treatment initiation to provide disease-specific education, review treatment options, and outline program expectations.
• Meet with patients completing treatment to provide education on hepatitis C and risk-reduction counseling to prevent reinfection.
• Deliver opioid overdose prevention training and facilitate access to naloxone.

Treatment Adherence

• Met with all hepatitis C patients prior to treatment to provide adherence education and assess readiness to engage in treatment.
• Met with patients on treatment to provide continued adherence education and support.
• Complete quantitative assessments of antiviral adherence for patients receiving treatment.
• Provide telephone support to remind patients of appointments or medication schedules.
• Aid patients with pillbox setup when needed.

Care Coordination

• Ensure patients are scheduled for all appointments required by the Hepatitis C Program.
• Collaborate with hepatitis C providers to ensure laboratory tests and referrals are ordered and completed.
• Follow up with patients who miss appointments or other program requirements.
• Provide referrals to appropriate internal and external resources, including insurance navigation, care management, partner notification, health education, housing, and harm-reduction services.
• Aid patients with applications for coverage of medical visits, laboratory fees, and medications (e.g., NYS HepCAP, Trillium Health Sliding Fee Scale, patient assistance programs, and prior authorizations through third-party payers).
• Serve as liaison with internal staff, pharmacies, home care services, and community agencies to promote linkage, retention, and treatment adherence.

Testing

• Provide rapid hepatitis C testing and dried blood spot confirmatory testing when necessary.
• Discuss risk-reduction strategies and assist clients in developing practical, client-centered risk-reduction plans.
• Connect clients to services and care.
• Provide condoms and other risk-reduction supplies.

Programming

• Present culturally competent educational and risk-reduction programming and hepatitis C prevention and treatment education to clients, patients, staff, volunteers, and community members.
• Ensure hepatitis C prevention is integrated into outreach and programming activities.
• Distribute current and appropriate educational and service materials during outreach, one-on-one encounters, and programming.

Administrative Services

• Document all services provided in accordance with funder and program protocols.
• Enter, compile, and report program data as required by program and funders.
• Maintain inventory of tools, patient education materials, and incentives.
• Prepare for and participate in monthly meetings to review caseload and quality data with the hepatitis C team.
• Participate in Hepatitis C QAPI meetings and complete quality improvement initiatives as assigned.
• Aid the Manager with tasks requested by Trillium Health leadership and/or the AIDS Institute, including monthly narratives and required documentation.

Required Skills/Abilities

• Experience in a community health role related to hepatitis C and familiarity with general health guidelines preferred.
• Experience in community health settings with direct patient care interaction required.
• Excellent communication and teaching skills.
• Bilingual preferred.
• Proficiency in word-processing and spreadsheet software required.
• Valid driver’s license and reliable transportation required.

Education And Experience

• High school diploma and five (5) years of related experience;
• Associate’s degree and three (3) years of related experience;
• Bachelor’s degree in Public Health, Psychology, Science, Health Education, Social Work, or a related field.