SUMMARY:

The Community Health Worker (CHW) is responsible for helping patients and their families to navigate and access community services, other resources, and adopt healthy behaviors. The CHW supports El Centro’s providers through an integrated approach to care coordination, care management, and community outreach. As a priority, activities promote, maintain, and improve the positive health outcomes of El Centro’s patients, their families, and East End residents. CHW provides social support and informal counseling, and advocates for individuals and community health needs.

ESSENTIALDUTIESAND RESPONSIBILITIES:

• Responsible for establishing trusting relationships with patients and their families while providing general support and encouragement.
• Provide ongoing follow-up, basic motivational interviewing, and goal-setting with patients/families.
• Follow–up with patients via phone calls, home visits, and visits to other settings where patients can be found.
• Help patients set personal health-related goals and attend appointments.
• Provide referrals for services to community resources as appropriate.
• Help patients connect with transportation resources and provide appointment reminders in special circumstances.
• Effectively communicating El Centro’s mission.
• Work closely with medical providers to help ensure that patients have comprehensive and coordinated care plans.
• Work collaboratively with other clinical personnel assigned to the same patient.
• Knowledgeable about community resources appropriate to the needs of patients/families.
• Responsible for providing consistent communication to the Case Manager or Care Coordinator to evaluate patient/family status, ensuring that provided information, and reports clearly describe progress.
• Act as a patient advocate and liaison between the patient/family and community service agencies.
• Record patient care management information in the EHR and other software no later than 24 hours after patient contact.

COMPETENCIES:

• Knowledge of mainstream and community resources located in the East End.
• Good organizational skills to handle multiple priorities while remaining professional and calm.
• Ability to work with many underserved and vulnerable populations such as people experiencing homelessness including youth and young adults, LGBTQI , Communities of Color, people living with behavioral health issues/concerns, etc.
• Strong level of confidentiality due to the sensitivity of materials and information handled.
• Ability to make suggestions on workflow or system efficiency and effectiveness.
• Ability to work independently and be self-directed and flexible.
• Ability to prioritize.
• Ability to perform functions with minimal supervision.
• Ability to work at a high-volume level of accuracy.

Education, Experience, Licensure/Certification and Skills/Abilities Related Requirements:

• Community Health Worker certification required
• Bachelor’s level degree in social sciences or social services preferred
• Must have had one year experience in the provision of services to chronic care patients.
• Must be able to demonstrate case management skills and knowledge of associated documentation.
• Must meet Standards of Care as prescribed by the respective funding source.
• Bilingual in English and Spanish (oral/written) required.