Hep C Patient Navigator

Project Description:
LEAP (Liver Education & Action Program) at Mount Sinai aims to improve the screening and linkage to care of hepatitis C virus (HCV) infection in New York City (NYC). HCV infection remains a major public health burden with many persons living with HCV not yet diagnosed and/or engaged in care. The LEAP Patient Navigator (PN) will work with patients and providers to reduce barriers to care and improve overall outcomes related to HCV screening.

The PN will work primarily on three projects, although duties may change to accommodate the evolving needs and activities of the LEAP program:

  • HCV testing and linkage to care through response driven sampling of persons who inject drugs (PWID): LEAP is partnering with researchers at another institution to screen PWID for HCV in NYC and link them to care as needed. At the partner site near in downtown Manhattan, the may PN work with clients to provide dried blood spot HCV RNA testing to confirm infection and counsel participants on their test results. For participants who screen positive, the PN will provide HCV counseling and linkage to care at a Mount Sinai clinic of the participant’s choice (several sites in Manhattan). The PN may also provide or organize accompaniments to the first appointment for patients who need additional support, potentially overseeing a peer navigator.
  • HCV Case Finding: LEAP is spearheading an innovative project to ensure all patients with HCV in the Mount Sinai Health System over the past decade have been linked to HCV care. This case finding effort involves extensive chart review in Mount Sinai’s EPIC electronic medical record (EMR), data entry and management in Excel, and outreach calls to patients who have not been treated and need linkage to care. The PN also schedules appointments, reschedules them as needed, provides appointment reminders, and follows up with each patient until they make it to their first appointment, when they connect them to a LEAP care coordinator.
  • Linkage to care for Emergency Department HCV Screening Pilot Initiative: The PN will follow up with patients who screen positive for HCV as part of a Mount Sinai Emergency Department HCV screening pilot initiative and ensure they come in for their first HCV appointment. This may involve coordinating with emergency department providers and staff, patients, administrative staff, other LEAP team members, etc. Follow-up may occur over the phone or in person. The PN may also provide or organize accompaniments to the first appointment for patients who need additional support, potentially overseeing a peer navigator.

The PN’s duties may include additional projects and responsibilities, including additional chart review, linkage to care, data management (possibly in REDCap, Excel, or Access), data reporting, and other duties to be determined.

The PN will also participate in weekly meetings with the LEAP team and directly report to the Program Manager with whom the PN will have regular one-on-one meetings. The PN will be responsible for periodically presenting cases and contributing to case conferencing with the team.

The PN may also be involved in outreach activities to expand the HCV screening and link to care model to health partners within our system. Outreach activities may include: delivering educational presentations, attending meetings, pre- and post-test counseling, and facilitating appointments in the clinic for those who test positive for HCV.

The PN is supervised by the Program Manager and Medical Director within the Division of Liver Diseases. This is an ideal position to gain experience in community health, research, and clinical medicine. Previous PNs have gone on to pursue advanced training in public health and medicine.

Additional details about responsibilities:

  • Navigate HCV-antibody positive patients to on-site viral load/confirmatory testing
  • Follow-up with all HCV Antibody positive patients screened for post-test counseling and basic HCV-related education: natural history, prevention of transmission, evaluation, and treatment
  • Accept and coordinate HCV referrals from providers in various settings to facilitate linkage to care
  • Schedule patients for all appointments including first on-site HCV evaluation with on-site HCV specialist, treatment meetings, and follow up appointments on-site and off-site
  • Provide reminders to patients prior to their scheduled appointment and check to see if patients adhered to appointment
  • Promote adherence to all HCV-related appointments and send letter and/or telegram for patients lost to follow-up
  • Review monthly data to identify screening rates and newly screened HCV+ patients to be linked
  • Obtain outside medical records as needed
  • Provide HCV education (evaluation, treatment, adherence, and side effect management)
  • Assist patient with referrals to social worker and other services to decrease barriers to care
  • Organize and administer any program incentives (e.g. metro cards)
  • Collect all HCV-related data and input in timely manner within databases
    • Maintain all HCV-related databases (e.g. updating data daily, ensuring data security)
    • Report weekly on database updates to HCV team
  • Provide weekly updates to HCV team meeting for problem solving, quality improvement, future grant applications
  • Attend on-site and off-site trainings as needed.
  • Attend New York City Department of Health HCV Task Force, when possible
  • Work closely with community contacts to develop and maintain HCV-related networks (e.g. syringe exchange program and community based organizations)
  • Collaborate with HCV team members in dissemination activities (abstracts and papers)
  • Other duties as needed

Education Training, Experience, and Skills:

  • Possess a Bachelor of Science in Public Health, Biology, Psychology, Education or related discipline
  • Have at least 2 years of experience in a community health role
  • Must possess knowledge of community resources and health care processes, structure, and function
  • Bilingual (English and Spanish) strongly preferred
  • Experience in a supervisory role preferred
  • Database management experience
  • Command of Microsoft Office Suite, experience with REDCap and EMR preferred
  • Must demonstrate ability to work effectively in a team environment
  • Exceptionally organized and able to work independently
  • Strong oral and written communication skills
  • Strong independent judgment
  • Flexibility to take on new duties as needed

Immediate start date. This position is funded through December 31, 2019, with the possibility of extension. Salary commensurate with experience.

Submit Cover Letter and Resume to: anna.mageras@mssm.edu

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