Peak Vista Community Health Centers is a nonprofit health care organization whose mission is to provide exceptional health care to people facing access barriers through clinical programs and education. We provide integrated health care services including medical, dental, and behavioral health through our 22 outpatient health centers. We deliver care with our strong "Hospitality" culture. Our organization has over 800 employees and serves more than 81,500 patients annually in the Pikes Peak and East Central regions of Colorado. Our service area covers 14 counties, from the front range to the Kansas border, with locations throughout Colorado Springs, Fountain, Flagler, Divide, Limon, and Strasburg. Peak Vista is accredited by the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC).    

Compensation (Pay): $21.11 to $30.61/hourly, based on experience.

Summary of Benefits:

• Medical, Dental, Vision, Life, STD, LTD
• 403(b) Retirement with Company Match
• Paid Time Off
• Tuition Assistance
• Perks Rewards
• Employee Assistance Program

https://www.peakvista.org/careers/employee-benefits-guide

Job Summary: Helps provide access to the right care, at the right time, in the right order, in the right setting with the right documentation. Works as a liaison between all modes of care. Responsible for working with the whole Care Coordination team in an interdepartmental effort to wrap around high-risk patients. Responsible for assisting high-risk patients in achieving maximum wellness through a collaborative, interdisciplinary process involving the patient, family and/or caregivers as well as providers and other support staff. This process includes assessment, planning, facilitation and advocacy through communication and the identification of available resources. Assists high-risk patients in identifying and obtaining services necessary to meet their overall needs and goals. This will in turn promote quality and cost-effective outcomes. High-risk factors may include more than one of the following:

• Age
• Poor pain control
• Previous home health and durable medical equipment usage
• Lack of social support
• Suicide Risk
• Chronic, catastrophic, terminal illness
• History of abuse, neglect
• Homelessness
• Transitional needs
• Poor nutritional status
• Financial concerns
• Repeated emergency department visits and/or hospitalizations
• Low functional status or cognitive deficit
• Co-morbid health conditions
• Mental illness or substance abuse
• Pervasive history of Guideline Non-Adherence
• Other identified high risk factors

Demonstrates competency using technology to include, but not limited to, the Electronic Health Record, Outlook, and Microsoft Office. Maintains documentation of all interactions accurately and completely. Assesses client’s psychosocial needs including health literacy status and care deficits (safety concerns and home layout barriers) and makes the appropriate referral for services. Assesses patient’s willingness to change. Coordinates care planning with client, family, or caregiver to maximize health care outcomes. Facilitates access to quality and cost-effective care. Coordinates and follows-up on referrals. Advocates and builds rapport with community agencies. Coordinates communication and education with members of the health care team. Educates the Care Team about community resources, and psychological or socioeconomic supports. Schedules patients as appropriate. This position involves driving to clients' homes or to various community locations for assessment, care planning, or follow-up. Scope of authority includes: providing resource coordination, follow up, patient education, and self-management education services to patients. Performs other duties as assigned.

Supervision Exercised: None

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Spanish bilingual preferred.

Education/Experience: Minimum 4-year degree in human service field or related medical field OR equivalent experience required.

Work Experience: Three years’ experience in case management, crisis intervention or client-centered counseling and extensive knowledge of community resources required.

Certificates and Licenses:

• Applicants must be at least 21 years of age or older to be an eligible driver on behalf of Peak Vista.
• Valid Colorado driver's license and proof of insurance. Must meet and maintain driver criteria as prescribed by Peak Vista's insurance underwriter.
• CPR Certification to be obtained within the first 90 days of employment. 

*Successful candidates will complete pre-employment screening; which includes, but is not limited to a Criminal Background check. Peak Vista Community Health Centers is a drug and alcohol free workplace an an Equal Opportunity Employer.

**PVCHC participates in the Electronic Employment Verification Program. E-Verify is an Internet-based system that compares information from an employee’s I-9 to data from the U.S. Department of Homeland Security and Social Security Administration Records. To learn more, visit: everify.com