The community health worker (CHW) will support and coach at-risk patients to manage their own health and assist them in navigating the health care and social service systems. CHWs work in safety net clinics, hospital systems, and community based agencies. Community Health Workers (CHWs) bridge the gap between health care providers and people in need of care. They serve as a link between the patient and the health or social service agencies.
· Assist patients in the community through home visits, attending medical appointments, and accessing other community-based resources. Although this position is based at the Health Center, CHWs are very mobile and spend a majority of their time actively working with patients in the community.
· Be onsite at assigned the Health Center, community-based agency, or hospital system and build relationships with site staff.
· Review referral forms, needs assessment screeners, or Electronic Medical Record data and determine appropriateness for project participation in conjunction with Project Coordinator. For patients not appropriate for project, provide active referrals to other community resources.
· Complete all telephone and face to face contacts with patients in a timely and professional manner.
· Complete enrollment forms and other needed documentation and document in approved format in a timely manner.
· Complete client-centered treatment goals in collaboration with patients and review progress in meeting goals routinely and at identified 60-day check-in times.
· Assist patient to schedule medical and social service appointments and attend appointments as needed or requested.
· Provide assistance with medical and behavioral health referrals to ensure client access and follow-through.
· Ensure clients access to interpreters and translators for medical and social service appointments.
· Assist patient in securing transportation to medical and social service appointments.
· Assist patient in obtaining necessary medications through patient assistance programs and other reduced cost programs.
· Assist clients in accessing and understanding necessary health and wellness information provided by their medical provider and clinic.
· Provide support and education to patients to assist them in adhering to medical recommendations and taking medications as prescribed.
· Provide regular and timely updates to medical providers, referral sources, and assigned clinics on patients' progress to meet treatment goals and to trouble shoot any problems or concerns.
· Complete all required documentation and data tracking in a detailed and timely manner.
· Attend and actively participate in all project related trainings and project meetings.
· Supports quality management and program evaluation activities through ongoing quality improvement process engagement.
· Assist with all other duties assigned.
· Must have strong PC proficiency and MS Office skills
· Must be able to manage time effectively in order to complete tasks and meet deadlines
· Must have good interpersonal skills with ability to relate to diverse groups of people and people on all levels
· Ability to prioritize workload and manage multiple tasks with different deadlines
Physical Demands/Working Conditions:
· Potential exposure to virus, disease and infection from patients in working environment
· While performing the duties of this job, the employee is regularly required to identify, communicate and exchange information
· The employee regularly is required to move about the building
· Expected to travel to community meetings, client homes or other agencies
· May experience traumatic situations including psychiatric traumatized and deceased patients
· Employee may regularly have to lift up to twenty (20) pounds