Clinical- Community Linkages Specialist
Job Details
Clinical- Community Linkages Specialist

The Fund for Public Health in New York City, (FPHNYC) is a 501(c)3 non-profit organization that is dedicated to the advancement of the health and well-being of all New Yorkers. To this end, in partnership with the New York City Department of Health and Mental Hygiene (DOHMH), FPHNYC incubates innovative public health initiatives implemented by DOHMH to advance community health throughout the city. It facilitates partnerships, often new and unconventional, between government and the private sector to develop, test, and launch new initiatives. These collaborations speed the execution of demonstration projects, effect expansion of successful pilot programs, and support rapid implementation to meet the public health needs of individuals, families, and communities across New York City.



The Clinical-Community Linkages team works with clinical and community organizations to eliminate health inequities related to the prevention and management of chronic conditions. The team works to increasing access to lifestyle management programs by building capacity for organizations to deliver programs and developing referral pathways between organizations. Targeted communities have substantially higher than city average rates of pre-diabetes, diabetes, hypertension and related morbidity and mortality and include populations that speak languages other than English. Culturally responsive programming including place-based strategies and health system collaborations are needed to achieve health equity in these communities.


The Clinical-Community Linkages Specialist will work on building capacity for the National Diabetes Prevention Program in communities within NYC and may support additional self-management programs such as the Diabetes Self-Management Program. This position will report to the Manager of Clinical-Community Program Linkages. The Clinical-Community Linkages Specialist will be responsible for the coordination of clinical and community-based organizations capacity to host and deliver lifestyle management programs with the aim of increasing access to and enrollment in these programs. The Clinical-Community Linkages Specialist will work to connect program providers with community resources to increase their participants engagement in lifestyle change. This work will require close collaboration with a variety of stakeholders including members of the Diabetes Prevention Recognition Program, as well as healthcare providers who will recruit and refer patients to these services. The Clinical-Community Linkages Specialist may also assist in identifying opportunities and incentives for collaboration as well as providing integrated workflows for providers to follow.



  • Provide guidance, training, and technical assistance for clinical and community-based organizations to develop sustainable prevention and self-management lifestyle management programming and workshops with an emphasis on cultural responsiveness.
  • Create and support workforce development efforts including performing trainings and developing supporting materials for coaches and peer leaders conducting lifestyle management programs.
  • Perform lifestyle coach and peer leader trainings for a diverse audience from clinical and community organizations. Implement modifications to the curriculum for the coaches training on an as needed basis.
  • Lead National Diabetes Prevention Program workshops as part of a broader worksite wellness initiative and/or community programming.
  • Perform quality control measure activities in collaboration with Equitable Health Systems Quality Improvement team to ensure referrals are being processed in a timely manner.
  • Monitor quality control measures related to post enrollment indicators (such as number of workshops hosted, workshop attendance, completion and attrition, weight lost, A1C, etc.)
  • Aggregate data to summarize trends (such as dropout rate by geography and socioeconomic indicators, completion rates, weight loss rates, etc.).
  • Develop close working relationships with a variety of clinical and community-based organizations.
  • Relay messaging and coordination plans between multiple stakeholders.
  • Leverage other NYC DOHMH initiatives for mutually reinforcing strategies to create streamlined efforts for chronic disease prevention and management.
  • Conduct needs assessments with our clinical and community partners.
  • Develop expertise in opportunities for lifestyle management programs to receive reimbursement through Medicare and Medicaid.
  • Occasional evening or weekend hours may be required.
  • Other duties, as assigned.




  • Bachelors degree; Masters degree a plus.
  • Two plus years of relevant work experience in a clinical or community-based setting.
  • Experience in health promotion or education.
  • Ability to work independently and exercise a high degree of initiative to accomplish tasks and solve problems while meeting deadlines.
  • Ability to deliver effective group workshops and trainings to virtual or in-person audiences.
  • Advanced skills in data management as well as the ability to analyze and present data to groups and individuals.
  • Strong relationship management skills.
  • Strong technology skills including ability to learn new systems and support partners to adopt and use them.
  • Strong written and oral communication skills required.
  • Commitment to teamwork.
  • Ability to travel within the 5 boroughs of NYC as in-person work resumes.



  • Masters Degree in public policy, public health, health administration, public administration, or related field
  • 3 or more years of professional experience in working with clinicians and community-based organizations.
  • Certified National Diabetes Prevention Master Trainer and/or Lifestyle Coach.
  • Certified Master Trainer and/or Peer Leader in the Self-Management Resource Center workshops.
  • Ability to conduct workshops or trainings in both English and another language or languages spoken by target communities such as Spanish, Haitian Creole, Korean, or Bengali.
  • Experience working with a variety of partners/stakeholders in both clinical and community-based settings.
  • Extensive experience using Microsoft Office (Teams, Excel, PowerPoint), videoconferencing (WebEx, Zoom etc.), and Salesforce.
  • Experience using Electronic Health Records.


There is a potential for this position to transition to DOHMH and therefore candidates must meet DOHMH eligibility requirements, including NYC residency.



FPHNYC offers a comprehensive benefits package. The salary range for this position is commensurate with experience and education.



To apply, send resume, with cover letter, including salary requested and how your experience relates to this position. We ask that you do not contact our staff directly and no phone inquiries please. Applicants who best match the position needs will be contacted for an interview.


The Fund for Public Health in New York City is an Equal Opportunity Employer and encourages a diverse pool of candidates to apply.