Community Health Worker

About the role

The Community Health Worker (CHW) supports patients and their families by navigating community services, resources, and healthy behaviors, while collaborating with providers and case managers through an integrated care management approach. Activities prioritize the health and well-being of patients and their families, including social support, informal counseling, and advocacy for individual and community health needs.

Responsibilities

• Educate members about ECM services, assist with enrollment, and serve as the primary liaison between members and needed services.
• Support individuals and families in navigating the health care system and improving self-care and health management.
• Establish trusting relationships with patients and families while providing general support and encouragement.
• Provide ongoing follow-up, basic motivational interviewing, and goal setting with patients and families.
• Bridge conversations with members and remove barriers to accessing health and social services; conduct face-to-face outreach for appointment scheduling, needs assessment, and care gap closure.
• Meet members in clinic, facility, or at home to identify social determinants of health affecting their well-being.
• Collaborate with the care team to create individualized, linguistically and culturally appropriate care plans.
• Assist members in accessing health-related services and community resources, including accompaniment to specialist appointments and help with enrollment forms.
• Facilitate communication among members, families, colleagues, and community-based organizations as needed.
• Document interactions with members and on their behalf in the medical record within 24 hours of contact.
• Follow up with patients via phone calls, home visits, and other settings where patients are found.
• Help patients set personal health-related goals and attend appointments.
• Provide referrals to community agencies and connect patients with transportation resources; offer appointment reminders when needed.
• Work effectively with patients, visitors, and staff; communicate COPE Health Solutions’ mission.
• Collaborate with medical providers to ensure comprehensive and coordinated care plans.
• Work with clinical personnel assigned to the same patient to support coordinated care.
• Knowledgeable about community resources appropriate to patients’ and families’ needs.
• Provide consistent communication to the Case Manager to evaluate patient/family status and clearly describe progress.
• Act as a patient advocate and liaison between patients/families and community service agencies.
• Record patient care management information in the EMR and other software within 24 hours of contact.
• Maintain assigned caseload of patients while ensuring HIPAA compliance.

Qualifications

• Valid California Driver’s License.
• High school graduate or equivalent required; Associate’s Degree in Business Administration or related field preferred.
• Successful completion of a Community Health Worker formal training program from a college or other education institution preferred.
• Written and oral fluency in English and Spanish preferred.
• Experience working in a multi-cultural setting.
• Willingness to learn and understand diverse cultures, perspectives, and norms.
• Experience working in a community-based setting for at least 1 to 2 years preferred.
• Basic computer skills required; electronic medical record (EMR) experience preferred.
• Understanding of the community served and community connectedness.
• Strong communication skills, including active listening and appropriate language use.
• Ability and willingness to provide emotional support, encouragement, and motivation to patients.

Competencies

• Strong organizational skills to manage multiple priorities while remaining professional and calm.
• Ability to work with diverse populations, including children and teenagers.
• Effective telephone skills.
• Strong confidentiality practices due to the sensitivity of handled information.
• Ability to suggest workflow or system improvements for efficiency and effectiveness.
• Capacity to work independently, be self-directed, and remain flexible.
• Strong prioritization and ability to perform with minimal supervision.
• Ability to work at a high-volume level with accuracy.

Position Expectations

• Commitment to the mission of COPE Health Solutions ECM Program.
• Professional behavior consistent with the values of respect, honesty, and dignity for patients, families, and health care team members.
• Dedication to continuous improvement and teamwork in enhancing patient and family care in the community.
• Punctuality and appropriate use of scheduled work time.
• Conscientious and cooperative performance of duties with minimal errors and timely task completion.
• Neat, professional appearance.
• Maintain confidentiality and protect program information by adhering to relevant laws and principles.

Benefits

• Comprehensive, affordable insurance plans for team members and their families.
• Yearly stipend for wellness-related activities.
• Paid parental leave program.