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Health Systems Navigator

3 months ago

Cambridge, United States Hildebrand Full time

The Health Systems Navigator will join one of the largest providers of services for

families experiencing homelessness in the Metro Boston Area. Founded in 1988,

Hildebrand is solely focused on families experiencing homelessness. Hildebrand’s

mission is to transition families out of homelessness to safe, affordable, permanent

housing while working to disrupt the systems that lead to poverty and homelessness.

Hildebrand operates 157 units of emergency shelter throughout the neighborhoods of

Boston and Cambridge and 22 units of affordable housing in four buildings, and an

array of services that include case management, housing search, and stabilization

services to ensure families remain stably housed. Hildebrand is a rapidly growing

organization with a staff of 60 employees and operates on a $9.1M budget.

Our vision is Every Family Has a Home.

SUMMARY:

Reporting to the Chief Program Officer, the Health Navigator (HSN) is an integral part of

Hildebrand's Management Team and is the subject matter expert for all health-related

matters for the clients and tenants of Hildebrand. The HSN will take a leadership role

within the Programs Department, helping to identify needs, improve client support

systems and support the overall department. The HSN will help families connect to

Community Health Centers and other resources that families can access while in shelter

and continue to access once they are stably housed. The HSN role aims to lessen

duplication of efforts in attempting to forge connections to community resources,

increase the ability to provide training on and develop expertise in system offerings, and

ultimately, improve family well-being. While health issues are the primary focus, the

Health Systems Navigator will develop expertise in other system offerings that intersect

with health-related issues. The HSN will balance high-level macro systems work and

collaboration with direct client support.

RESPONSIBILITIES:
• Respond to challenges in identifying available services and making effective

referrals – particularly for families with complex needs.
• Develop and maintain an approach and internal system for dealing with client’s

complex medical issues.
• Provide greater context to staff, including management and case management,

on how client issues are related to social determinants of health.
• Develop and maintain connections to Community Health Centers, helping to

develop partnerships and collaborations leading to greater access, resources,

and training for Hildebrand clients and tenants.
• Coordinate client care plans with hospital social workers for complex client

medical issues.
• Support Case Managers, ensuring clients are connected to MassHealth or other

health insurance, accessing its benefits, and clients are up to date on physicals

and immunizations.
• Ensure staff are trained in signing clients up for MassHealth and benefits and in

conjunction with program supervisors and managers, are tracking all relevant

health information.
• Act as a specially trained, on-demand connections expert who is knowledgeable

about service availability and eligibility and connects with key individuals in other

systems, including regional CoCs.
• Ensure the client board and ETO is up-to-date with the latest client information.
• Function as the organization’s ADA Coordinator for the purposes of HLC ADA

requests. Track and follow up on ADA requests and support clients directly if

additional ADA navigation is needed. Act as an intermediary between HLC and

staff regarding ADA concerns.
• Connect with new clients and/or homeless coordinators at intake to ensure new

housing placements accommodate individual ADA requirements.
• Address ADA needs across all of Hildebrand’s portfolio, including permanent

housing.
• Review and update Hildebrand’s permanent housing ADA and pet policies on an

annual basis.
• Review and update intake procedures for healthcare and ADA information.
• Lead the review and certification process for verifying disabling conditions for

permanent supportive housing disability status.
• Provide ADA support for stabilization clients, helping to inform landlords of

clients' accommodation needs and legal protections.
• Ensure clients are staying connected to their health services when transferring

internally or moving to a new permanent housing address by confirming clients’

MassHealth ACOs and health centers are still appropriate
• Ensure permanent housing follows ADA guidelines for tenants and provide

oversight to the tenant selection process around disabilities.
• Review all SIRs with health-related issues and develop preventative plans to

minimize the use of Emergency Services.
• Coordinate health-related workshops.
• Set up vaccination clinics with partners.
• Triage contagious disease situations alongside public health departments and

medical guidance.
• Provide support for permanent housing families with health-related questions and

needs.
• Ensure Program staff is up-to-date on First Aid CPR, and other client safety

training.
• Ensure all clients are provided with safe sleep information and program staff are

documenting safe sleep instructions with staff.
• Participate in 1 round of unit inspections annually with an eye on the health and

well-being of each family.
• Ensure Hildebrand is meeting the Health and Safety requirements for families in

shelter in line with the scope of services.
• Interface (virtually and on-site) with shelter staff and act as in-house consultants

and support systems to case managers, housing search and stabilization staff

who are struggling to help families navigate complex bureaucracies.
• Focus on the most complex or unique cases where standard case management

approaches are insufficient.
• In collaboration with the Education/Health Navigation Consultant, support and

mentor health-focused interns.
• Specific Health Navigator activities include (but are not limited to):

1. Aiding case managers in identifying available services and helping

navigate eligibility requirements, especially for families with particularly

complex needs, with the focus on making connections to permanent

services that can be maintained post-placement.

2. Developing community linkages with CoC’s and other state and non-profit

entities to ensure effective connections to services, including but not

limited to services providing:

a. Health Care; Mental Health; Substance Abuse; Food and Nutrition;

3. Provide trainings to shelter staff regarding the above community resources

and other resources alongside community-based organizations and

community health centers.

4. Participate in HLC-facilitated trainings and knowledge-sharing on

navigating services across the Commonwealth.

5. Help inform HLC ongoing work with Executive Office of Health and Human

Services (EOHHS) agencies and CoC’s by identifying areas where

coordination could be improved and where service gaps exist.

6. Continue aiding families in connecting to appropriate services and

navigating complex Health systems once housed.

7. Track and aggregate data and report out monthly on Health and system

navigation efforts.

QUALIFICATIONS:
• MSW, MPH or related Masters
• 1 - 2 years of experience in case management and direct client work.
• Current working knowledge of homelessness and Continuum of Care Programs.
• Proven ability to successfully manage several projects simultaneously,

quickness, agility, and ability to exercise sound judgment in managing a crisis..
• Excellent verbal and written communications skills.
• Possesses excellent communication and interpersonal relationship skills in order

to collaborate effectively with staff members, general public, and representatives

of other organizations.
• Demonstrated commitment to use innovative ideas in order to address and meet

needs of families experiencing homelessness.
• Experience working with people from broadly diverse ethnic, social and cultural

backgrounds.
• Understand and uphold the highest level of confidentiality on all levels including

the ability to uphold HIPAA compliance standards.
• Computer knowledge and proficiency required including Microsoft Office

applications, including Word, Excel, Access, PowerPoint and Outlook.
• Experience providing trainings.
• Experience with data reporting.
• Previous experience working in or in conjunction with community health centers

or hospitals and or strong knowledge of public health.
• Demonstrated commitment to use innovative ideas in order to address and meet

needs of families experiencing homelessness.
• In depth knowledge of MassHealth, Massachusetts hospital systems, and

MassHealth ACO benefits.

ADDITIONAL INFORMATION:
• As with all Hildebrand staff positions, a CORI and SORI check is required.
• Some non-traditional work hours may be required around the Holiday events.