Lead Care Manager; CHW; Street Medicine

Description

Wellness Equity Alliance (WEA) is a novel national public health organization comprised of a multidisciplinary team of population and public health experts with backgrounds in infectious disease, public health, emergency medicine, primary care, cardiology, pediatrics, psychiatry, community health work (CHW), nursing and advanced practice pharmacy. We work nearly exclusively with underrepresented communities, fundamentally addressing health-care disparities and the social determinants of health (SDoH) that have been amplified during the COVID-19 pandemic, prioritizing the following:

• People experiencing homelessness
• Indigenous communities
• Immigrant communities
• Rural communities
• BIPoC communities
• LGBTQIA+ communities
• Justice-impacted communities

The WEA team is diverse, inclusive, and nimble enough to assemble teams of healthcare professionals within days using our proven local staff recruitment models to address population health crises and communicable disease outbreaks. The WEA team’s partnership model is collaborative and allows hospitals, health jurisdictions, state/local government agencies to provide timely care using equity-based strategies for individuals and marginalized communities.

This position is focused on conducting community outreach among unhoused populations. The Community Health Outreach Worker (CHOW) care coordinator will play a crucial role in identifying individuals with active HIV/HCV and STI cases and ensuring they are connected to appropriate care. This includes verifying that patients have received the correct treatment and follow-up care. Staff selected for this role will contribute to a vital and sustainable street medicine program designed to serve unhoused communities in the Victorville area.

Often, the most vulnerable individuals experiencing homelessness have encountered repeated failures from institutions throughout their lives, leading to a deep mistrust of authorities, institutions, and healthcare providers. This mistrust, while initially a form of self-protection, can become a significant barrier to accessing care and resources that could significantly improve their quality of life.

The street medicine team will work to build trusting relationships with people who are in need of medical services, work to decrease the logistical barriers that block access to health care and provide care directly to the places where unhoused individuals live.

• Assist with daily site/program operations, such as mapping team efforts for the day or week
• Review supplies needed for each patient outreach encounter
• Evaluate program performance through key performance indicators and monitor for improvement opportunities
• Conduct outreach activities within a specific health program and/or defined patient populations with the goal of engaging multiple local businesses, schools, and other relevant organizations in our public and community health services
• Conduct telephonic and/or face-to-face outreach with patients to identify social determinants of health impacting patient's health and overall wellness
• Utilize coaching, motivational interviewing, and other evidence-based techniques to support patients in achieving their goals
• Utilize technology and digital resources to monitor ongoing care activities
• Identify barriers to achieving targeted clinical or social outcomes, and engage the care team to revise the care plan when necessary
• Documents all participant encounters; completes and submits monthly reports; maintains comprehensive electronic participant files. Documents activities, service plans, and outcomes achieved by study participants in an effective manner
• Assists participants in accessing health-related services, including but not limited to: overcoming barriers to obtaining needed medical care and /or social services
• Assists participants in utilizing community services, including scheduling appointments with health resources, and assisting with completion of applications for programs for which they may be eligible
• Works collaboratively and effectively within a team. Establishes positive, supportive relationships with participants and provides…