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Community Network Pt Liaison

Location: Houston Methodist Hospital
6565 Fannin St, Houston, TX 77030
Job Ref:
68831
Talent Area:
Professional
Job Shift:
1st - Day
Job Type:
Full-Time
Posted Date:
March 26, 2025

At Houston Methodist, the Community Network Patient Liaison position is responsible for identifying patients eligible for the Houston Methodist Network of Care Program, facilitating medical home access, and supporting patients in closing the gap with social drivers of health. This position is responsible for screening patients for eligibility, rounding on patients while inpatient and in the home setting, determining the appropriate medical home for the patients and addressing the social determinant(s) of health that may serve as barriers to health care access, if applicable.

Requirements:

PEOPLE ESSENTIAL FUNCTIONS
  • Identifies patients in need of medical home and provides referral support services to those eligible for Houston Methodist Network of Care Program. Collaborates with patients post discharge to support management of chronic illness.
  • Oversees and coordinates the entire patient experience at hospital and during post discharge transitions in care.

SERVICE ESSENTIAL FUNCTIONS
  • Communicates Network of Care resources to eligible patients while complying with Houston Methodist patient experience service standards.
  • Coordinates inpatient activities for patients to establish with medical homes including, but not limited to, giving appropriate and timely follow up, coordinating with Network of Care Program securing medical records as needed, assisting with scheduling clinical appointments, program orientation and assisting with medical home selection and education.
  • Serves as a collaborator between Community Benefits and Case Management at designated hospital to provide appropriate care resources to eligible patients.
  • Coordinates meetings and communicates with manager as appropriate.
  • Explains policies, procedures or services to patients using medical or administrative knowledge when appropriate and delivers culturally competent care and appropriate services to all managed patients.
  • Coordinates care for patients until arrival of the initial primary care appointment at medical home including, but not limited to, appointment reminders, transportation arrangement, prescription assistance and financial assistance. Supports patients to post discharge appointments.

QUALITY/SAFETY ESSENTIAL FUNCTIONS
  • Provides appropriate and accurate documentation/tracking system for each patient.
  • Maintains knowledge of community services and resources available to patients.

FINANCE ESSENTIAL FUNCTIONS
  • Documents all pertinent patient information for tracking/reporting purposes in Epic Network of Care platform.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS
  • Promotes the importance of medical homes with Federally Qualified Health Center (FQHC) partners and other post discharge referrals.
  • Leads special projects and committees as assigned.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

Qualifications:

EDUCATION
  • Bachelor's degree, preferably in business, health care or related field

WORK EXPERIENCE
  • Three years of related experience, healthcare preferred
LICENSES AND CERTIFICATIONS - REQUIRED
  • CHW - Community Health Worker (TDSHS) -- If current HM employee, must obtain certification within 12 months of the job description revision

KNOWLEDGE, SKILLS, AND ABILITIES

  • Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
  • Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
  • Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
  • Advanced proficiency in oral and written English and at least one foreign language, Spanish preferred
  • Thorough understanding of health care insurance options and knowledge of protocol related to each
  • Knowledge of medical terminology and hospital operations preferred
  • Effective interpersonal, organizational and analytical skills, and a flexibility to handle multiple tasks and changing priorities in a dynamic setting

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

  • Uniform No
  • Scrubs Yes
  • Business professional Yes
  • Other (department approved) No

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

  • On Call* No

TRAVEL**
**Travel specifications may vary by department**

  • May require travel within the Houston Metropolitan area Yes
  • May require travel outside Houston Metropolitan area No

Company Profile:

Houston Methodist Hospital is recognized by U.S. News & World Report as the No. 1 hospital in Texas and one of America’s “Best Hospitals.” As a full-service, acute-care hospital located in the Texas Medical Center and the flagship hospital of Houston Methodist, it has evolved into one of the nation’s largest nonprofit teaching hospitals and a leader in innovative medical research with a comprehensive residency program. Two of Houston Methodist’s primary academic affiliates are among the nation’s leading health care organizations: Weill Cornell Medicine and New York-Presbyterian Hospital. Houston Methodist also has affiliations with Texas A&M University and the University of Houston. With 948 operating beds, 85 operating rooms and more than 8,400 employees, Houston Methodist Hospital offers unparalleled care for thousands of patients from around the world.

Houston Methodist is an Equal Opportunity Employer.

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