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The Johns Hopkins University Guiding and Improved Dementia Experience (GUIDE) program, funded by the Centers for Medicare and Medicaid Services (CMS), is seeking a dedicated and proactive
Community Outreach Specialist. This individual will support persons with dementia and their caregivers in navigating resources, health care services, and social supports, with a focus on culturally competent, person-centered care.
The Community Outreach Specialist will utilize standardized protocols to assist in assessments and care planning and facilitate education and connection to community-based services while contributing to the national evaluation of this multi-year dementia care model. This position will report to the Administrative Program Manager for the GUIDE Program and will work closely with an interdisciplinary care team. Specific Duties & Responsibilities
- Manage a caseload of program participants, using project registries to ensure consistent care coordination.
- Administer questionnaires and protocol-based assessments of care needs and social determinants of health.
- Use protocols to help develop and support a care plan agreed upon by the interdisciplinary team
- Assist patients and caregivers with community resource linkage.
- Maintain up-to-date knowledge of community resources and service availability.
- Provide dementia education, caregiver support, and symptom management coaching under the supervision and guidance of the interdisciplinary care team
- Serve as a trusted liaison between patients, families, health care providers, and community resources.
- Maintain regular contact with patients and families per CMS and internal program protocols
- Document all client interactions accurately and timely within the electronic health record and other tracking systems. (Epic and Craniometrix software)
- Participate in weekly interdisciplinary team meetings.
- Engage in ongoing job training and development, including required initial and continuing education on dementia care
- Travel to patient homes and community-based sites as required.
- Assist with collecting questionnaires required by CMS for initial and annual patient alignment
- Adhere to all HIPAA, CMS, and JHU policies regarding privacy, documentation, and safety.
Minimum Qualifications
- High school diploma or graduation equivalent.
- Two years of related experience.
- Additional education may substitute for required experience and additional related experience may substitute for required education beyond a high school diploma/graduation equivalent, to the extent permitted by the JHU equivalency formula.
Preferred Qualifications
- Associate's or Bachelor's Degree in a relevant field.
- Experience supporting older adults, caregivers, or individuals living with dementia.
- Experience with case management or patient navigation.
- Lived experience caring for individuals with chronic illness or dementia.
- Residency or strong familiarity with the local Maryland counties served.
Classified Title: Community Outreach Specialist
Job Posting Title (Working Title):Community Outreach Specialist (Psychiatry & Behavioral Sciences)
Role/Level/Range: ACRO37.5/02/CC
Starting Salary Range: $15.70 - $26.25 HRLY ($49,774 targeted; Commensurate w/exp.)
Employee group: Full Time
Schedule: Monday - Friday, 8:30am - 5:00pm
FLSA Status:Non-Exempt
Location: Hybrid/Johns Hopkins Bayview
Department name: SOM Psy Bay BV Geriatric and Neuropsychi
Personnel area: School of Medicine
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Johns Hopkins University
Jan 23, 2026