Community Health Worker - Street Medicine

About the role

As a Community Health Worker (CHW) within Neighborhood’s Enhanced Care Management (ECM) program, you will partner with patients experiencing unsheltered homelessness to improve whole-health outcomes through outreach, engagement, and navigation of community resources. This role is embedded in the Street Medicine program and requires frequent community-based encounters alongside clinical settings. All non-clinical support staff share responsibility for driving Neighborhood-branded vehicles to deliver services in the field.

Responsibilities

• Maintain situational awareness and ensure scene safety during community-based encounters.
• Conduct proactive outreach to build trusting relationships with patients and provide general support and encouragement.
• Manage an ongoing caseload of ECM patients, including:
  • Scheduling appointments and completing EMR registration.
  • Using basic motivational interviewing and goal-setting techniques.
  • Conducting phone calls, home/living-environment visits, and visits to other patient locations.
  • Addressing access barriers to help patients attend appointments.
  • Providing referrals to community agencies as appropriate.
  • Connecting patients with transportation resources and delivering appointment reminders.
  • Assisting patients with applications, registration forms, eligibility determination, enrollment, and follow-up for uninsured individuals.
  • Liaising between patients and community service agencies to ensure needs and rights are met; collaborating with providers to ensure continuity of care.
  • Navigating the healthcare system on behalf of patients through phone and in-person follow-ups.
  • Documenting and sharing patient barriers with the ECM team and primary care provider to improve care and outcomes.
  • Using evidence-based approaches such as motivational interviewing to foster patient self-efficacy and collaboration with care teams.
  • Communicating clear, culturally appropriate health and wellness information to patients and explaining ECM benefits and services.
  • Advocating for patients in their home or living environment to community and provider organizations.
  • Building and maintaining positive working relationships with providers across multiple communication channels.
  • Representing the community voice to help teams understand patient culture, norms, beliefs, and preferences.
  • Collaborating on message creation and delivery that align with community culture.
  • Participating in weekly case reviews, consulting with the patient’s primary care provider before taking clinical action, and ensuring documentation is accurate, timely, and compliant with regulatory and accreditation standards (recorded in eCW and managed care plans within one day).
  • Attending required staff meetings and other assigned activities.

Education & Experience

• High school diploma or GED required.
• Current Basic Life Support (BLS) certification required at hire and maintained thereafter; courses must follow AHA guidelines and may be completed through approved providers such as ProMed.
• Two years of experience in healthcare, behavioral health, street medicine, or social services required.
• Valid California driver’s license and proof of auto insurance required.
• Experience working with unsheltered homeless populations and/or personal lived homelessness experience preferred.
• Experience in outreach and customer service within medical office and behavioral health environments, particularly with individuals managing substance use disorder and mental health issues, preferred.
• Bilingual (English/Spanish) preferred.

Additional Qualifications

• Meet Neighborhood vehicle-driver eligibility requirements to support shared field-service driving responsibilities.
• Knowledge of and experience with diverse cultural issues (e.g., immigration, socioeconomic status, LGBTQIA+, seniors).
• Knowledge of and experience with trauma-informed practices, mental health conditions, and addictive disorders.
• Intermediate computer and data-entry skills.
• Ability to apply emotional and cultural intelligence to tailor communication and patient care.
• Capacity to engage patients across settings: phone, in-person/homes, community streets or shelters, and healthcare environments.
• Familiarity with community-based resources, especially non-professional resources and their local reputation.
• Skill in building relationships with community patients and leaders, including faith-based organizations.
• Sound decision-making and judgment to anticipate patient needs and escalate appropriately to supervisors and experts.
• Excellent verbal and written communication, including composition, typing, and proofreading.
• Ability to interpret instructions in written, oral, diagram, or schedule form.
• Capacity to manage multiple tasks, shifting priorities, and time-sensitive deadlines.
• Strong planning, organization, teamwork, and relationship-building skills.
• Ability to work independently and as part of a team while handling highly confidential information ethically and professionally.
• Physical ability to lift/carry up to 20 lbs and stand for extended periods.

Pay

$24.95 – $34.93 per hour, commensurate with experience.

Compensation Disclosure: Actual pay will reflect the candidate’s overall knowledge, skills, and experience; market data; internal equity; budgetary considerations; and organizational needs.