What are the responsibilities and job description for the Community Health Worker position at Smart Prime Care?
Job Summary
Community Health Worker — Patient Navigator ("Kit Buddy")
Company: Seva Healthcare IT LLC
Reports to: Supervising Nurse Practitioner/Physician (Smart Primary Care, general supervision) and MyKitBuddy navigation team lead
Employment type: Part-time
Location: Field-based / hybrid — mix of in-person patient contact and virtual outreach required
Responsibilities
MyKitBuddy is hiring Community Health Workers to serve as Kit Buddies — dedicated patient navigators who help people manage their health journey after a diagnosis of a serious illness (cancer, heart failure, COPD, dementia, and others) or when a social or practical barrier is getting in the way of their care. This role delivers Medicare's Principal Illness Navigation (PIN) and Community Health Integration (CHI) services under the general supervision of a licensed practitioner. This is not a clinical role — it is a relationship-driven role built on trust, communication, and persistence.
Key Responsibilities -
- Conduct person-centered assessments to understand each patient's specific needs in the context of the condition their doctor is treating
- Coordinate care across providers — following up on referrals, confirming appointments happened, and closing the loop when something falls through
- Help patients navigate the health system: understanding insurance, scheduling, prior authorizations, and next steps after a visit
- Connect patients to community resources — transportation, food assistance, housing support, and other services addressing practical barriers to care
- Translate medical information into plain language and support patients in understanding their own care plan
- Coach patients in self-advocacy — helping them feel prepared and confident participating in their own care decisions
- Document every encounter in the MyKitBuddy platform for review by the supervising practitioner
- Maintain a mix of in-person and virtual patient contact each month, consistent with CMS requirements for this service
- Build toward a full active caseload of approximately 130–150 patient contacts per month (roughly 6–8 per working day) within two to three months of starting
Required Qualifications -
- Current Community Health Worker certification where required by state law, or willingness to obtain it within [X days] of hire
- Demonstrated experience working with patients managing serious or chronic illness, or with underserved/complex populations
- Strong communication skills across a range of health literacy levels and, ideally, languages relevant to the communities served
- Comfortable using a mobile app or platform for scheduling, documentation, and patient communication
- Reliable transportation and willingness to travel locally for in-person patient visits
- Ability to work independently while following a supervising practitioner's treatment plan and direction
Preferred Qualifications -
- Training or certification specific to oncology, cardiac, or pulmonary patient navigation (for example, through the Harold P. Freeman Patient Navigator Institute)
- Prior experience as a CHW, patient navigator, peer support specialist, or in a home health/social services role
- Bilingual or multilingual
- Familiarity with Medicare and Medicaid systems and common barriers beneficiaries face
What Success Looks Like -
- Patients feel genuinely supported and know who to call when something in their care feels unclear or stuck
- Referrals and follow-up appointments are completed on time, not left to chance
- Documentation is complete and audit-ready for the supervising practitioner's monthly review
- Caseload ramps steadily toward full capacity within the first two to three months
Compensation & Schedule -
- Salary commensurate with experience and local market, benchmarked against national Community Health Worker compensation data. Full-time schedule with some flexibility to accommodate patient availability, including occasional evening or weekend contact when needed.
Pay: $22.00 - $23.00 per hour
Work Location: Hybrid remote in Fredericksburg, VA 22408
Salary : $22 - $23