The Health Care Guide brings value to Primary Care by facilitating access to solutions, quality outreach, goal setting, problem solving, navigation, and closing the loop on open tasks. A focus area for guides is coaching around lifestyle changes to promote health and well-being. The Health Care Guide may room patients, check vital signs, and manage flow within the clinic. The Health Care Guide maintains working relationships with KPWA teams to improve coordination and integration. Communication with members may be face-to-face or virtual, real time or asynchronous. Health Care Guides are accountable for a defined population, can initiate encounters, and document in the electronic medical record.
Capture relevant information about the patient’s health and healthcare experience, take vitals, administer point-of-care testing, and perform standard age and condition-appropriate screening assessments.
Take responsibility (in partnership with providers) for the health of a population of patients and monitor and track whether those patients are up to date on preventive measures.
Provide disease specific self-care education and coaching to members enrolled in disease management programs.
Identify transitional care gaps and coach members to access appropriate services Identify needed community and medical/behavioral services to support members’ goals and coach members to access them.
Identify member’s clinical and non-clinical needs and report to appropriate care team member.
Use motivational interviewing skills to develop short and long-term goals with members.
Using evidence-based information and coaching skills, will work with members to set health related goals and develop and implement effective strategies to reach those goals.
Establish healing relationships with members and families.
Coach patients using an action-planning model based on motivational interviewing techniques.
Assist with the coordination of care across the continuum, such as: coordinating referrals, and sharing or transferring information with the patient’s internal and external care team.
Regularly monitor member’s progress towards meeting their health goals and communicate progress to interdisciplinary team.
Document all interactions and coaching sessions, assessments, care plans, and interventions in EPIC system Documents member goals, clinical data, behavioral outcomes, and administrative details of all assigned members.
Consult and collaborate with interdisciplinary team, other internal departments, particularly health services and medical management, to support multidisciplinary care.
Participate broadly in the daily operations of a primary care practice.
Other duties as assigned.
Minimum two (2) years of experience providing direct services to customers.
Per the National Agreement, current KP Coalition employees have this experience requirement waived.
High School Diploma OR General Education Development (GED) required.
Graduate of accredited program as Medical Assistant.
License, Certification, Registration
Medical Assistant-Certified credential OR Interim Medical Assistant-Certified credential by date of hire/transfer.
Excellent customer service experience.
Intermediate computer literacy including Word, Windows, Excel, and Social Media.
Ability to participate and collaborate in a team setting.
Good organizational skills.
Strong communication skills.
Ability to multi-task.
Intermediate familiarity with, and active in, local community.
Three (3) years of experience providing direct services to customers.
Experience interacting in a diverse, multicultural and/or multilingual environment.
Demonstrated leadership through professional, volunteerism or community activities.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
To apply for this job please visit www.kaiserpermanentejobs.org.