Community Health Worker

About the role

The Community Health Worker (CHW) is a grant-funded 3-year position as part of the CHW Asthma Initiative. The CHW will promote the health and well-being of patients and families by providing re-education and coaching on disease/health management with a focus on asthma and asthma management. They will conduct home visits and healthy home assessments, working with families to promote health and asthma trigger-free households.

Responsibilities

• Establish trusting relationships with patients and their families while providing general support, encouragement, and promoting general health and well-being.
• Advocate, facilitate, and organize access to health and social services with/for families to improve health and well-being of the community at large, particularly those families who have children diagnosed with asthma.
• Provide case management of non-medical needs to a caseload of high-needs families through regular and ongoing communication, ensuring engagement and a collaborative approach to working with them through an integrated approach to care management and community outreach.
• Utilize EMR to document patient care and communicate with primary care team as well as collect data at set intervals through assessment tools, collaborating with leadership to reflect issues affecting health and gauge patient progress.
• Conduct intake interviews with patients/families, including enrolling and/or referring patients into appropriate community programs. Provide referrals for services to community agencies as appropriate. Identify, create, and nurture relationships with local agencies, schools, churches, and other programs that can provide services to children and their families.
• Provide health re-education on topics related to medications, therapies, health promotion, and informal counseling. Accomplished through partnership with patients' medical team, social work, and care coordinators for follow-up with patients/parents via phone calls, home visits, and visits to other settings where the patient can be found.
• Aid in managing care and care transitions for vulnerable populations by establishing supportive relationships with families via regular and ongoing communication to identify and address issues that may contribute to poor health and readmissions. Help patients connect with transportation resources and give appointment reminders as appropriate. Collaborate with the medical and social work team to address and document non-medical issues that affect the health of patients, including all social determinants of health needs such as food insecurity, financial hardships, transportation, housing, violence prevention, etc.
• Utilize problem-solving skills to assist in unusual or difficult patient/family situations. Assist with access to medical insurance, specialty pharmacies. Refer to CHW Asthma Role and Responsibilities.

Qualifications

• Minimum of one year of prior experience as a Community Health Worker or related experience providing education to individuals on health management.
• High school diploma required.
• Expectations: Attend CHW Core Competency training program, become certified as an asthma educator within 3 months of hire, attend and complete motivational interviewing training, and attend basic skills for working with smokers training.

About Us

Nemours Children's Health is an internationally recognized pediatric health system serving more than 1.7 million patient encounters each year. We deliver care across six states through two freestanding children's hospitals—Nemours Children's Hospital, Delaware and Nemours Children's Hospital, Florida—along with a network of more than 80 primary, urgent, and specialty care practices and more than 40 hospital partnerships. Backed by the Nemours Foundation and Alfred I. duPont Trust, our $1.7B nonprofit system is dedicated to improving children's health through clinical care, research, education, advocacy, and prevention. Our Whole Child Health approach focuses equally on prevention and treatment, partnering with communities to help every child thrive. Inclusion and belonging guide our strategy and growth. We are committed to culturally relevant care, reducing health disparities, and fostering an environment where every associate, patient, and family feels supported and valued.