Community Health Worker

Essential Duties

• Educating clients about ECM services, assisting them with enrollment and serving as the primary liaison between the client and any services they may need
• Facilitate outreach and engagement activities internally/externally to generate referrals and enrollment into ECM; including but not limited to member information lists provided by Managed Care Plans, street outreach, participation in resource fairs, and/or co-location at partner sites.
• As liaison across internal programs to promote intra-agency referrals into ECM. Responsible for building trusting relationships with partners and referring parties to facilitate enrollment in ECM.
• Responsible for establishing trusting relationships with clients and their families while providing general support and encouragement
• Helping bridge conversations with clients, in partnership with Lead Care Manager, and removing barriers that prevent them from accessing health and social services; and conduct face-to-face outreach to a panel of clients for appointment scheduling, needs assessment, and care gap closure
• Meet clients in clinic, facility or at home to help identify social determinants of health impacting their health and general well-being
• Collaborate with the full care team to create an individualized, linguistically, and culturally appropriate care plan for every enrolled client
• Aids clients in accessing health-related services and community resources, such as accompaniment to specialist appointments and assistance with enrollment forms
• Facilitate communication between all parties (clients, families, colleagues, and community-based organizations), as needed, ensuring that provided information, and reports clearly describe progress
• Help clients set personal health related goals and attend appointments
• Help clients connect with transportation resources and provide appointment reminders in special circumstances
• Knowledgeable about community resources appropriate to address the needs of the client
• Act as a client advocate and liaison between the client/family and community service agencies
• Record all client care management information in the Care Management System and other software no later than 24 hours after client contact
• Manage assigned caseload of clients
• Maintain HIPAA compliance at all times

Essential Skills

• Demonstrable knowledge and skill in case management and supervision, social services, and organization skills
• Good organizational skills to handle multiple priorities while remaining professional and calm
• Ability to work with many diverse people, including children and adolescents
• Effective telephone skills
• 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 perform functions with minimal supervision
• Ability to work at a high-volume level of accuracy
• Behave in a professional manner and consistently demonstrate and promote the values of respect, honesty, and dignity for the patient, families, and all members of the health care team
• Committed to the constant pursuit of excellence and teamwork in improving the care of the patient and families in the community
• Be punctual for scheduled work and use time appropriately
• Perform required amount of work in a timely fashion
• Be neat and maintain a professional appearance
• Maintain confidentiality and protect the program by abiding by laws and principles related to confidentiality; keep information concerning program operations, patients, and employees confidential