Resource Specialist

Resource Specialist

Research indicates housing, food, financial and other forms of socioeconomic insecurity, impact health outcomes. To improve our patients’ health and wellbeing, MGH primary care patients are asked to complete a social determinants of health (SDH) survey annually. The goal is to identify and address SDH early by assessing and referring patients to internal and external resources. This role will also participate in additional Medicaid ACO programming as needed.

Assess patients who have screened positive on one or more of the SDH questions

• Determine the scope of the patient’s need


• Identify previous or current efforts to address the need


• Identify previous or current engagement with internal and/or external resources

Provide patient education and referral to resources

• Identify and provide information on the network of services and eligibility including service provider addresses,
  

telephone number and, as available, contact person; may involve investigation and outreach to internal

and community providers

• Follow up with patient within 2 weeks of referral to confirm engagement and respond to outstanding questions or re-refer as appropriate.


• Connect to primary care practices, as appropriate, to connect patients to formal case management or social work programs.

Documentation

• Use Epic smartphrases to document engagement with patient including education and referral to resources


• Use Epic CC charts to communicate with the patient’s care team about engagement with the patients, referrals and other appropriate patient information.


• Help create data tracking system to document and assess incoming and outgoing referral rates.


• Identify and document gaps in internal and external services and improve workflows and resource tools when needed.

• High School Degree required; Bachelor’s Degree preferred

• Human services experience and knowledge of community resources preferred.

• Attention to detail and ability to comprehend and educate about systems with complex eligibility requirements.
  
• Assessment and problem-solving skills.


• Strong interpersonal skills.


• Strong Customer Service skills.
  
• Ability to work independently with minimal supervision.


• Goal oriented and accountable in a complex medical environment.


• Demonstrated organizational and time management skills.


• Strong oral and written communication skills. Good computer skills.


• Bilingual preferred