GUIDE Care Navigator
University of Pennsylvania

University OverviewThe University of Pennsylvania, the largest private employer in Philadelphia, is a world-renowned leader in education, research, and innovation. This historic, Ivy League school consistently ranks among the top 10 universities in the annual U.S. News & World Report survey. Penn has 12 highly-regarded schools that provide opportunities for undergraduate, graduate and continuing education, all influenced by Penn's distinctive interdisciplinary approach to scholarship and learning. As an employer Penn has been ranked nationally on many occasions with the most recent award from Forbes who named Penn one of America's Best Large Employers in 2023.Penn offers a unique working environment within the city of Philadelphia. The University is situated on a beautiful urban campus, with easy access to a range of educational, cultural, and recreational activities. With its historical significance and landmarks, lively cultural offerings, and wide variety of atmospheres, Philadelphia is the perfect place to call home for work and play.The University offers a competitive benefits package that includes excellent healthcare and tuition benefits for employees and their families, generous retirement benefits, a wide variety of professional development opportunities, supportive work and family benefits, a wealth of health and wellness programs and resources, and much more.Posted Job TitleGUIDE Care NavigatorJob Profile TitleCoordinator BJob Description SummaryThe Penn Memory Center at the University of Pennsylvania seeks to hire a Care Navigator to join their multidisciplinary team to support the Guiding an Improved Dementia Experience (GUIDE) program. The GUIDE program provides comprehensive, coordinated dementia care and aims to improve quality of life for people with dementia, reduce strain on their caregivers/support network(s), and enable people with dementia to remain in their homes and communities. This full-time position in an outpatient practice in the Perelman Center for Advanced Medicine will be responsible for supporting older adults with Alzheimer's disease and other dementias, and their caregivers/support network(s). The Care Navigator will serve as a primary point of contact for patients with dementia and their caregivers, providing continuous, proactive, and personalized support. The Care Navigator collaborates with physicians, nurses, social workers, and other members of the care team to provide support, education, and care coordination to patients with dementia and their caregivers. The Care Navigator is the primary point of contact for patients and their caregivers enrolled in the program. The Care Navigator will participate in training on common issues affecting patients with dementia and their caregivers. They will maintain regular contact with program participants. They will review clinical cases weekly with other care team members. They will assist with collecting data on patient quality of life, caregiver distress, and health-related social needs. They will report to a social worker or nurse manager and will also provide feedback directly to clinicians and other care team members.Job Description

Job Responsibilities

1. Primary Contact and Support:
o Act as the primary point of contact for patients with dementia and their caregivers to gauge completion of specific health interventions outlined in the Care Plan; such as, completion of appointments, medication compliance, use of community resources and other recommended follow-up activities.
◦ Provide education about dementia, its progression, and what to expect.
◦ Offer emotional support and active listening to caregivers.
◦ Under clinical supervision, ask screening questions and document patient safety, behavior, function, medications, care needs, and advanced care plans
◦ Under clinical supervision, ask screening questions and document caregiver issues such as burden, depression, and poor coping
1. Care Coordination:
◦ Screen for unmet care needs, including clinical or medication issues, behavioral issues, safety risks, and psychosocial well-being.
◦ Provide connections to local community services and resources.
◦ Assist with medication reconciliation and medication management strategies, including monitoring for side effects and changes in function or behavior.
◦ Monitor delivery of care through documentation and tracking of interventions in the electronic health record (specialty visit follow-up, labs, diagnostic studies, etc.).
2. Person-Centered Planning:
◦ Assist with developing and maintaining personalized care plans that incorporate the beneficiary's goals, strengths, preferences, and needs.
◦ Help guide each dyad through the process of advance care planning.
◦ Modify care plans as needed to reflect changes in circumstances, goals, and preferences.
◦ Ensure care plans are incorporated into the beneficiary's electronic health record and shared with their primary care provider and other relevant healthcare providers.
3. Education and Training:
◦ Educate caregivers on managing dementia-related behaviors, maintaining safety in the home, and other caregiving tasks.
◦ Provide resources to help caregivers maintain their well-being and manage stress.
◦ Participate in Care Navigator training for their own professional development (initial and ongoing)
4. Ongoing Monitoring and Support:
◦ Maintain regular contact with beneficiaries and their caregivers, adjusting the frequency of contact based on the patient's complexity and needs
◦ Use various modalities (in-person, phone, video calls) for ongoing contact.
◦ Ensure 24/7 access to support for beneficiaries and caregivers during business hours.
5. Collaboration with Clinical Team:
◦ Consult with and escalate complex or medical issues to licensed clinical team members, such as clinicians, nurses, social workers, or pharmacists.
◦ Report screening to the clinical team who will provide direction in implementing a care plan with the Care Navigator, patient, caregiver, health care and community service providers.
◦ Participate in interdisciplinary team meetings to coordinate care and address any emerging issues.

Qualifications

• Bachelor of Arts, Bachelor of Science, Bachelor of Fine Arts, and 2 to 3 years of experience or equivalent combination of education and experience is required.
• BSW or other human services degree preferred
• Strong communication and organizational skills
• Ability to develop rapport with persons with dementia and caregivers while maintaining professional boundaries.
• Problem-solving skills and the ability to think critically and creatively.
• Basic understanding of medical issues commonly faced by persons with dementia and their caregivers, such as delirium, falls, infections, medication side effects, etc.
• Training in aging, dementia care, and advance care planning (provided as part of the role).
• Experience in health care or social work is beneficial but not required.

This position is contingent upon grant funding.

Job Location - City, StatePhiladelphia, PennsylvaniaDepartment / SchoolPerelman School of MedicinePay Range$43,919.00 - $60,000.00 Annual Rate

Salary offers are made based on the candidate's qualifications, experience, skills, and education as they directly relate to the requirements of the position, as well as internal and market factors and grade profile.

Affirmative Action Statement
Penn adheres to a policy that prohibits discrimination on the basis of race, color, sex, sexual orientation, gender identity, religion, creed, national or ethnic origin, citizenship status, age, disability, veteran status, or any other legally protected class.

Special Requirements
Background check required after a conditional job offer is made. Consideration of the background check will be tailored to the requirements of the job.

University Benefits

• Health, Life, and Flexible Spending Accounts: Penn offers comprehensive medical, prescription, behavioral health, dental, vision, and life insurance benefits to protect you and your family's health and welfare. You can also use flexible spending accounts to pay for eligible health care and dependent care expenses with pre-tax dollars.

• Tuition: Take advantage of Penn's exceptional tuition benefits. You, your spouse, and your dependent children can get tuition assistance here at Penn. Your dependent children are also eligible for tuition assistance at other institutions.

• Retirement: Penn offers generous retirement plans to help you save for your future. Penn's Basic, Matching, and Supplemental retirement plans allow you to save for retirement on a pre-tax or Roth basis. Choose from a wide variety of investment options through TIAA and Vanguard.

• Time Away from Work: Penn provides you with a substantial amount of time away from work during the course of the year. This allows you to relax, take vacations, attend to personal affairs, recover from illness or injury, spend time with family-whatever your personal needs may be.

• Long-Term Care Insurance: In partnership with Genworth Financial, Penn offers faculty and staff (and your eligible family members) long-term care insurance to help you cover some of the costs of long-term care services received at home, in the community or in a nursing facility. If you apply when you're newly hired, you won't have to provide proof of good health or be subject to underwriting requirements. Eligible family members must always provide proof of good health and are subject to underwriting.

• Wellness and Work-life Resources: Penn is committed to supporting our faculty and staff as they balance the competing demands of work and personal life. That's why we offer a wide variety of programs and resources to help you care for your health, your family, and your work-life balance.

• Professional and Personal Development: Penn provides an array of resources to help you advance yourself personally and professionally.

• University Resources: As a member of the Penn community, you have access to a wide range of University resources as well as cultural and recreational activities. Take advantage of the University's libraries and athletic facilities, or visit our arboretum and art galleries. There's always something going on at Penn, whether it's a new exhibit at the Penn Museum, the latest music or theater presentation at the Annenberg Center, or the Penn Relays at Franklin Field to name just a few examples. As a member of the Penn community, you're right in the middle of the excitement-and you and your family can enjoy many of these activities for free.

• Discounts and Special Services: From arts and entertainment to transportation and mortgages, you'll find great deals for University faculty and staff. Not only do Penn arts and cultural centers and museums offer free and discounted admission and memberships to faculty and staff. You can also enjoy substantial savings on other goods and services such as new cars from Ford and General Motors, cellular phone service plans, movie tickets, and admission to theme parks.

• Flexible Work Hours: Flexible work options offer creative approaches for completing work while promoting balance between work and personal commitments. These approaches involve use of non-traditional work hours, locations, and/or job structures.

• Penn Home Ownership Services: Penn offers a forgivable loan for eligible employees interested in buying a home or currently residing in West Philadelphia, which can be used for closing costs or home improvements.

• Adoption Assistance: Penn will reimburse eligible employees on qualified expenses in connection with the legal adoption of an eligible child, such as travel or court fees, for up to two adoptions in your household.

To learn more, please visit: https://www.hr.upenn.edu/PennHR/benefits-pay

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