Roots Community Health Center·San Jose, California
The role involves implementing care coordination and outreach for high-priority conditions like Diabetes and Substance Use Disorder. Responsibilities include tracking patient visits, managing referrals, and collaborating with care teams to ensure timely reporting and patient engagement.
Representing Roots Community Health Center as part of the Clinical Programs team, this position implements care coordination and outreach for high priority conditions such as Diabetes, HIV, Hepatitis C, Opioid Use Disorder, unsheltered status and complex care. This role will specifically support our Diabetes and Substance Use Disorder programs. The Clinical Program Specialist provides superior client/patient service, and interacts with team members/clinic personnel, employees of other departments, physicians’ offices and hospitals, as well as the public. The Clinical Program Specialist oversees large client panel lists and uses prioritization skills to proactively track and coordinate patient visits, specialty referrals, and outreach activities in a timely and effective manner. This position will monitor, communicate with the care and program teams, and document activities using several client/patient tracking systems and Electronic Health Records to make sure communications, care coordination, and reporting requirements are timely, accurate and effective.
? Conduct outreach to increase awareness of clinical programs in the community and to partner organizations. ? Conduct "in-reach" to current patients and members to increase engagement in clinical programs. ? Collaborate with patients' navigation team members to coordinate care and share patient progress. ? Maintain up-to-date and accurate service information in program-specific patient tracking systems on a daily basis. ? Support group visits or activities and assist with distribution of incentives to program participants. ? Work with the patient’s care providers to support the patient in recommended visit schedules. ? Outreach to patients to educate them about clinical programs under the direction of the Clinical Programs Manager. ? Work with Administrative staff to ensure accurate documentation and reporting. ? Outreach and promote Roots events, campaigns and classes. ? Provide relevant information to the team to support the strategic development of the programs. ? Attend regular program meetings to discuss status of service coordination, challenges/barriers to conducting the work, including hard to reach patients or workload. ? Identify and report issues that require escalation to the next level of management for resolution. ? Willingness to shift to new processes, projects, etc. as needed. ? Attend and participate in MAA Implementation Trainings. ? Back up or coordinate with Patient Care Coordination staff to verify insurance, referrals, and appointment scheduling. ? Attend organizational and other trainings and meetings related to job role. ? Must be able to work on-site full time.
Competencies ? 1 year experience performing clinical, coordination, and/or administrative functions preferred. ? Strong interest in healthcare, social determinant of health and health disparities. ? Interest/experience working with low-income communities of color. ? Excellent written and verbal communication skills. ? Excellent team-player. ? Ability to manage multiple phone lines, spreadsheets and files. ? Ability to work with patients from different backgrounds. ? Strong working knowledge of Microsoft Office and G-Suite. ? Ability/willingness to learn Electronic Health Records and multiple reporting systems.
Roots Community Health Center is proud to be an Equal Employment Opportunity/Affirmative Action Employer and values diversity of culture, thought and lived experiences. We seek talented, qualified individuals regardless of race, color, religion, sex, pregnancy, marital status, age, national origin or ancestry, citizenship, conviction history, uniform service membership/veteran status, physical or mental disability, protected medical conditions, genetic characteristics, sexual orientation, gender identity, gender expression regardless of physical gender, or any other consideration made unlawful by federal, state, or local laws. Roots uses E-Verify to validate the eligibility of our new employees to work legally in the United States.
Market context
In California, behavioral-health roles tied to substance use disorder counseling and case management are typically supported by ongoing community and treatment-program demand. These positions are competitive because employers often look for a high school diploma, at least 2 years of SUD counseling or case management experience, and current Registered or Certified Drug and Alcohol Counselor status. Review the AI-summarized requirements and benefits here to quickly compare fit and note that professional development and paid continuing education are listed as benefits.