Community Health Worker Certified-2

Job Duties

• Orients and assesses new Community Health Workers.
• Provides regular assessment of the level of proficiency demonstrated by staff during the orientation period in order to support decisions to move staff along in training or refocus until proficiency is met.
• Affords assistance in the identification and outreach of medically complex patients.
• Collaborates with the multidisciplinary team in the development and implementation of the care plan.
• Engages patients via phone call, home visit, hospital visit, and accompanying patients to provider appointments as needed.
• Completes vital signs.
• Identifies gaps in care and connects members with resources.
• Facilitates telemedicine visits with members and providers.
• Performs disease-specific education.
• Conducts Medication Reviews to ensure medication adherence.
• Conducts safety evaluations in patients' homes.
• Facilitates adherence to treatment plans by early identification and resolution of gaps in care.
• Communicates all concerns to the clinical team and manager as necessary, seeking support and guidance proactively.
• Participates in multidisciplinary team conferences in order to maximize the treatment plan.
• Provides reinforcement of the treatment plan under the direction of the Case Manager and Licensed Social Worker and is available for consultation and case review as needed.

About the Role

The Certified Community Health Worker (CCHW) within the Social Needs Resource Hub (SNRH) provides patient-centered outreach, primarily through telephonic engagement, to individuals with identified social needs. Working within a team-based model, the CCHW collaborates with healthcare teams, community-based organizations (CBOs), and hub colleagues to assess needs and coordinate appropriate support. The CCHW utilizes motivational interviewing and problem-solving techniques to educate patients and connect them to community resources that address social determinants of health, including transportation, food insecurity, housing, financial strain, and utilities. This role includes facilitating referrals and partnering with CBOs through the Neighborly platform to ensure timely and effective linkage to services. The CCHW conducts follow-up outreach to confirm successful connections and address barriers, supporting a shared team workflow and accountability model. Accurate and timely documentation within Geisinger’s electronic medical record (EMR) is required to capture outreach efforts, referrals, and outcomes, supporting reporting, quality improvement, and program evaluation.

Job Requirements

Minimum of 1 year-related work experience (Required)

Qualifications

High School Diploma or Equivalent (GED) (Required)

Skills

• Problem Solving
• Clerical I
• Communication
• Multitasking

About Geisinger

Founded more than 100 years ago by Abigail Geisinger, the system now includes ten hospital campuses, a 550,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,700 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually. Learn more at geisinger.org or connect with us on Facebook, Instagram, LinkedIn and Twitter.

Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

Our Vision & Values

Everything we do is about making better health easier for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

Our Benefits

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and prescription coverage.