Evergreen Health At Evergreen Health and our affiliates, we value collaborative, down-to-earth individuals and encourage self-expression. We recognize that our diverse workforce allows us to provide culturally competent care to everyone in our community. The Retention Specialist addresses individual barriers preventing some persons living with HIV from engaging and adhering to HIV care and treatment in Evergreen Health’s Primary and Specialty Care Services. They complete assessments surrounding treatment readiness, barriers to care, and social determinants of health. They provide strategic interventions through service plan development, routine contact and linkage and navigation of supportive and medical services. The Retention Specialist works collaboratively with the entire Retention & Adherence Program Team (RAP) with a goal of improving health outcomes and building the capacity of people living with HIV to independently manage their health care and achieve sustainable viral load suppression. As part of the essential functions of this role, the Retention Specialist:
Reviews, understands, and has a working knowledge of the grant work-plan from which program funding is obtained including all deliverables and required data/statistical requirements. They follow all standards and/or guidelines as defined by the New York State Department of Health
Provides all services according to the established AIDS Institute’s Retention and Adherence Services Program Guidelines including intakes, assessments/reassessments, service plans, coordination, monitoring of medical treatment, education, patient self-management etc. These services are provided directly with each enrolled patient prioritizing needs and setting specific goals and objectives to meet them. Through routine contact, the Retention Specialist will continue to assess retention issues and adjust services as changes occur
Escorts patients during routine medical appointments at Evergreen Health to coordinate care and ensure accurate and up-to-date communication with patients’ medical provider
Provides, tracks and verifies linkage and referrals to all appropriate wrap-around services and programs available throughout Evergreen Health and the community to address identified barriers or challenges
Ensures patient retention in care through monitoring, patient reminders and identifying and addressing any barriers directly, or through referrals if necessary
Responsible for patient lists that will be extracted from the EMR regularly and monitored to address challenges/barriers in collaboration with the RAP Team. The lists will identify patients who may have fallen out of care, monitor patient attendance and/or viral load progression/regression and track individual patient patterns
Participates in regular internal case conferences with the Medical Director, other Primary & Specialty Care medical providers and the RAP Team. Coordinates case conferences with internal and external service providers regarding common patients as necessary to meet patient needs
Maintains complete, current and accurate patient files through the electronic medical records system (Medent) complying with agency protocols and confidentiality policies
Provides a welcoming and customer service-oriented experience for patients that is rooted in harm reduction and is trauma-informed. Maintains a cooperative and professional approach toward co-workers and all internal and external medical and supportive service providers
They collaborate and support the team members to ensure a patient-focused approach to care
Qualified candidate will have a Bachelor’s degree in health, human, or education services with one year of qualifying experience, OR Associate’s degree in health, human, or education services with two years of qualifying experience. Candidate must have strong written, verbal, organizational, customer service, and time management skills. Candidate must have a valid driver’s license and ability to travel between offices/clinic locations and/or other destinations as necessary. Candidate must demonstrate an awareness of and sensitivity to the issues that underserved populations, people living with HIV and people who use drugs face, including health disparities that affect people of color at a disproportionate rate
Qualifying experience means verifiable full- or part-time experience in care coordination or clinic setting with the following populations: person with a chronic illness, and/or persons with a history of mental illness, homelessness, or chemical dependence. Experience with families preferred.
Job type: Full-time
Required education and experience: Bachelor’s degree with one year of qualifying experience OR Associate’s degree with two years of qualifying experience
Additional requirements: Valid NYS driver’s license and insured, dependable car
What Evergreen Health Offers You:
Multiple comprehensive medical health insurance plans for you to choose from
Dental and Vision coverage at no cost to you
Paid Time Off package that equals 4 weeks of time in your first year
403b with a generous company match
Paid parking or monthly metro pass
Professional development opportunities
Paid lunch breaks
