Life Coach (Mary Immaculate)
WHY WORK WITH CCEVA
PURPOSE OF THE JOB:
- Medical Assistant, Pharmacy Tech, Emergency Medical Technician, or LPN
- High school diploma
- Ability to operate a variety of standard office machines and equipment. Two to three years’ experience
in human services, case management and/or work with families. Experience working with healthcare
systems and community-based organizations. Experience working with multicultural communities in a
culturally competent manner.
- Mastery of basic computer skills and be computer literate
- Must have a valid Virginia driver’s license
- A commitment to serving vulnerable populations.
- Must agree to and pass a drug test, TB skin test, background check and present current driving record
KNOWLEDGE, SKILLS AND ABILITIES:
- Knowledge of chronic illnesses
- Knowledge of community resources
- Knowledge and understanding of low-income and minority communities in Newport News and
- Knowledge of prescription medications
- Ability to check patients’ understanding of their discharge plan and chronic disease management
- Ability to assess patients’ needs
- Ability to set priorities and execute independent judgment
- Ability to communicate effectively, orally and in writing
- Ability to work well with a variety of stakeholders
- Coordination, planning and organization skills
- Skilled in gathering and reporting information, as well as record keeping. Ability to work effectively
with staff, community members, family members, and external agencies.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
- Full Life Coach Patient: These are Patients who have Chronic Diseases or are high utilizers of the ED and need a Primary Care Home. Life Coach follows these patients closely and keeps detailed records on services provided, returns to the ED, chronic conditions, time it takes to get them into a physician etc. Also works with these patients to connect them to area resources to address any additional needs they may have.
- Brief Service/Information Referral Patients: These are patients who may not have a chronic condition but need assistance in finding a Primary Care Physician or specialist, need resources to address other needs aside from their current health situation. The Life Coach will work with patients to connect them to what they need, but there will not be detailed information kept on these patients or any follow up inquires made.
Responsibilities Of Life Coach for Full Life Coach Patients
- Connect patients with chronic diseases to a Primary Care Home (PCH) and counsel on importance of using PCH instead of ED (Emergency Department) to handle routine care of diseases
- Connect high utilizers of the ED to a Primary Care Home (PCH) and counsel on importance of using PCH instead of ED to handle routine care of diseases
- Schedule appointments to both primary care practitioners and acute / specialty care and give patients their plan of follow up care upon discharge from the ED
- Provide reminder calls to Life Coach Patients for their upcoming appointments; evaluate any barriers keeping them from going to appointment and work with patients to remove barriers
- Arrange or Provide transportation to appointments when necessary
- Provide follow up calls to ensure patients went to their appointment and if they liked the physician and will be going back for continued service
- If patient did not like the office/physician/clinic will continue to work with patient to find a fit they are comfortable with
- If patient misses appointment will continue to work with patient and schedule two more times. If both are missed, then Life Coach will wait until patient says they are ready to do what is needed
- If patient comes in after hours; the Emergency Staff can order a Life Coach Consult and Life Coach will reach out to patient the next business day and provide same services as if they were in ED
- Provide and connect to area resources for issues outside of needing a Primary Care Physician But staying within the scope of the Life Coach Program
- Document in Hospital Database on patient and what services provided and or connected to
- Enter Full Life Coach patients into CCEVA database in order to track information
- Track and document return visits of Full Life Coach patients to the ED for 90 days
- If patient returns for true emergency Life Coach will reach out to the patient and ensure They have let their primary care doctor know they were in the ED and if they have scheduled a follow up appointment with them
- If patient returns for a Primary Care issue, the Life Coach will reach out to patient and find out if patient is still connected to initial Primary Care Home and remind patient that they should have gone there for issue they came to ED for
Responsibilities for Information/Referral and Brief Service Patients
- Schedule appointments and give patients their plan of follow up care upon discharge from the ED
- Connect patients to area resources to address needs outside of follow up care such as:
Clinic information, Shelter or Housing information, Drug or Alcohol Rehabilitation Services, Social Services information, Charity Care information, low cost prescription drug information, obtaining identification, Clothing, Food Pantries, Food Stamps, Support Groups, Information about other agencies, Financial assistance, Eye glasses, Health Insurance, Medication Assistance, etc.
- Document in Hospital Database on patient what services provided and or connected to
- Document all services provided or Information and Referrals given in CCEVA database for Reporting purposes
Reports To Be Provided:
- Monthly Brief Narrative of what Life Coach did for the month or a description of a case where the Life Coach went above and beyond for a patient
- Return visits to be documented in Apricot monthly for reporting requirements
WORK DEMANDS & ENVIRONMENT
- Ability to stoop, lift (ex. pick, pinch, type, or grasp)
- Exerting up to 20lbs of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull or otherwise move objects.
- Ability to inspect and analyze figures, accounting items, written materials, newsprint, computer terminal characters, transcription, and other similar objects at distances generally close to the eyes.
- The worker is subject to a variety of inside environmental conditions that may occur in an office, private home, or elsewhere in the community
- When required, serve as liaison, communicating formally and informally with community groups, health care providers, official agencies and individuals to advance the program
- Identify and maintain relationships with a multi-disciplinary network of clinicians, dentists, outreach workers, public health professionals, social workers, and others as needed to provide comprehensive quality care
- Participate in continuing education programs to enhance performance of job duties
- Perform other duties as assigned
- Respond to agency needs in line with abilities, interest and changing community needs
- Business casual or scrubs
- Closed-toe shoes that are good for walking