Community Health Worker (CHW)- On-Site/ Field-Based

** This role provides on-site and field support across partnered health centers in Richfield and Kanosh, UT. Candidates must reside within commuting distance of local clinic sites. ** About Activate Care: At Activate Care, we're on a mission to improve health equity and drive improved health outcomes across the country. Our Community Care Record platform enables healthcare and community organizations to coordinate care for populations challenged with health-related social needs. Path Assist is our tech-enabled community health worker program for HRSN utilizing an evidence-based, structured intervention. Our goal is simple: increase health confidence, improve self-efficacy, and reduce inappropriate healthcare spending. Role Overview: Activate Care is seeking a Community Health Worker (CHW) to support the Utah LIFT Path Assist for Chronic Disease program. The CHW will work closely with patients, participating FQHC clinics, and Activate Care's program team to help adults with chronic conditions overcome barriers to care, successfully access telehealth services, and use digital tools and approved educational resources to support chronic disease self-management. Each CHW will be aligned with a participating clinic(s) and will provide a combination of in-person, telephone, video, secure messaging, and technology-enabled support. The CHW will serve as a trusted connection between patients, clinical teams, and community resources while helping patients develop and achieve individualized health goals. The CHW is a non-clinical role and will not diagnose, prescribe, or provide medical advice. Clinical questions and concerns will be escalated to the appropriate licensed healthcare provider. Responsibilities: Conduct outreach to patients referred by participating FQHC clinics and explain the Path Assist programEngage eligible patients in the program and complete consent, required intake, assessments, and enrollment activitiesIdentify patient-specific goals and barriers and document support and follow-up providedMaintain regular contact with participants based on their level of need and program requirementsSupport patients with appointment preparation, follow-up, and completion of recommended servicesSupport patients in understanding and following next steps recommended by the patient's healthcare teamTrack goals, tasks, referrals, and progress throughout the participant's enrollmentSupport patients in using CareLink Navigate for secure communication, reminders, education, goal tracking, and resource navigationAssess each patient's comfort with technology, internet connectivity, digital literacy, and readiness to use telehealthHelp patients understand when and how telehealth may be used as part of their careSupport telehealth scheduling, reminders, visit preparation, technology setup, and connectivity troubleshootingCoach patients on use of smartphones, patient portals, video platforms, and other approved digital tools as neededHelp patients overcome technology-related barriers that may prevent them from completing telehealth visitsFollow up after telehealth encounters to support completion of provider-recommended next steps and identify any additional access barriersProvide education and coaching related to chronic disease self-management, leveraging and distributing relevant WebMD Ignite chronic disease materialsHelp patients access and understand approved educational materials and provider-recommended next stepsUse motivational interviewing, health coaching, and goal-setting techniques to support patient engagement and follow throughIdentify barriers that may interfere with chronic disease management and work with patients to develop practical solutionsRefer to local disease self-management programs as relevantScreen for social needs that may affect the patient's health or ability to follow their care plan, including transportation, food access, housing, affordability, language, health literacy, and other barriersRefer patients with identified health-related social needs to Utah 211 for resource navigation and assistanceHelp patients utilize the CareLink Navigate self-service resource directoryHelp patients identify and address practical barriers to health and social care accessDocument patient outreach, assessments, care plan-related goals, referrals, interventions, follow-up, and outcomes in CareLink accurately and in a timely mannerCollaborate closely with clinic staff to support referral, communication, and care coordination workflowsCommunicate patient barriers, care-coordination needs, and relevant updates to authorized clinic staffFollow established clinical escalation protocols when a patient reports symptoms, concerns, or needs outside the CHW scope of practiceParticipate in clinic huddles, case reviews, or implementation meetings as appropriateBuild strong working relationships with providers, care teams, community partners, and other members of the LIFT programParticipate in CHW supervision, coaching, continuing education, and performance feedbackSupport program goals related to enrollment, engagement, screening, referrals, goal-setting, telehealth access, and participant retentionMaintain strict compliance with HIPAA, privacy, security, documentation, and program policiesOther duties as assigned Requirements Qualifications & Skills: High school diploma or equivalent requiredCommunity Health Worker (CHW) certification or prior experience in CHW, patient navigation, care coordination, peer support, health education, or community outreach roles preferredExperience working in an FQHC, rural healthcare setting, Medicaid program, or community-based organization preferredExperience supporting patients with chronic conditions using motivational interviewing, health coaching, or chronic disease self-management techniques preferredStrong interpersonal, communication, and relationship-building skills with the ability to build trust across diverse communitiesComfort working with patients who may face complex medical, social, financial, transportation, language, or technology barriersStrong ability to use computers, smartphones, web-based platforms, digital health tools, patient portals, or care-management platforms for documentation and communicationStrong organizational skills and ability to manage multiple patients, tasks, and follow-up activities independently and collaborativelyKnowledge of local Utah community resources preferredBilingual or multilingual skills (particularly Spanish) strongly preferredAbility to travel locally to assigned clinic and community locations as needed; valid driver's license and reliable personal transportation required Diversity & Inclusion: At Activate Care, we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates without regard to race, color, religion, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, military, and veteran status, and any other characteristic protected by applicable law. Activate Care believes that diversity and inclusion among our teammates is critical to our success as a company, and we seek to recruit, develop and retain the most talented people from a diverse candidate pool. The organization is committed to providing reasonable accommodations to qualified individuals with disabilities throughout the hiring process. If you require an accommodation to participate in the interview process, please let our team know at the time of scheduling. The Company will not sponsor applicants for work visas at this time.