Blood Pressure, Calendar Management, Coaching, Community Health, Community Programs, Community and Social Services, Computer Skills, Cross-Functional, Customer Support/Service, Health Education, Health Plan, Healthcare, High School Diploma, Interpersonal Skills, Medications, Microsoft Excel, Microsoft Office, Microsoft Word, Nutrition, Patient Assessment, Patient Care, Physical Demands, Presentation/Verbal Skills, Problem Solving Skills, Psychiatry and Mental Health, Social Work, Time Management, Training/Teaching, Writing Skills
JOB SUMMARY
The Community Health Worker will provide comprehensive support services to patients and their families with medical, dental, social, and mental health needs. The position includes interacting with patients in a Primary Care setting, in the patients home, and in the community. The Community Health Worker will be responsible for establishing interpersonal relationships with patients and their families. The individual will function in a multidisciplinary team providing holistic care aimed at improving overall health. The Community Health Worker will be responsible for helping patients and their families navigate and access community services, other resources, and adopt healthy behaviors. The Community Health Worker will aim to improve adherence to health recommendations, reduce inappropriate healthcare utilization, and enhance communication between the patient and the healthcare team.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Interacts with patients, community members, families, and members of the care team to provide a range of care services. Specific duties and responsibilities include:
- Care Coordination
- Providing health education and coaching
- Facilitating health promotion
- Assisting patients in accessing medical and dental services including establishing Medical and Dental homes
- Remote care management including Self Measured Blood Pressure Devices
- Organizing and providing patient outreach
- Promoting patient health engagement
- Assessing and responding to an individuals needs involving Social Determinants of Health including but not limited to transportation, nutrition, and housing.
- Helping patients develop health management plans and goals
- Coaching patients in effective management of their chronic conditions and self -care
- Helping patients understand their care plan
- Helping patients to utilize community resources including but not limited to scheduling appointments and application assistance
- Continuously assessing a patients eligibility for State, Federal, and community-based programs designed to improve a patients Social Determinants of Health
- Follow up on referrals to specialist and community-based organizations
- Facilitating self-management workgroups
- Assisting patients in obtaining affordable medication
- Supporting behavioral change using motivational interviewing
- Advocating for individual and community needs
- Performing other functions or duties as assigned
MACHINERY AND EQUIPMENT USED
Personal computer and printer, copier, calculator, telephone, and facsimile machine
KNOWLEDGE, SKILLS AND ABILITIES
- Strong relationship-building
- Strong written and verbal skills
- Good time management, organizational, and problem solving skills
- Ability to present in a professional manner benefiting the organization
- Willingness to work flexible hours
- Ability to seek supervision when needed or appropriate
- Ability to work as a member of an interdisciplinary team and in an interagency collaboration
- Strong interpersonal skills (proficiency in interviewing, basic negotiation, and mediation)
- Strong computer skills (Microsoft Office Word, Excel).
EDUCATION
Bachelors in Social Work preferred. High School Diploma or GED required.
EXPERIENCE
N/A
CERTIFICATE/LICENSE
N/A
PHYSICAL DEMANDS AND WORK ENVIRONMENT
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.
While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or finger, handle, or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch, or crawl.
The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision, and the ability to adjust focus.
The noise level in the work environment is usually moderate.