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Family Health Worker

    Highlights

    Family Health Workers (FHWs) are integrated as critical members of clinical healthcare teams across the health system to help patients identify and navigate clinical and community resources, remain engaged in clinical care, and empower themselves to advocate for their own health. We provide care across the lifespan, including primary care for children and adults; prenatal and reproductive health services; specialty referral management; integrated behavioral health; mental health counseling; case management and entitlements assistance; and health education.

    Numbers & Facts

    Location
    IndustryHealthcare Services
    Company Size10,000 employees or more
    Websitehttp://www.montefiore.org/

    Description

    City/State:

    Bronx, New York

    Grant Funded:

    Yes

    Department:

    BHC - Patient Services Longwood A

    Bargaining Unit:

    1199

    Work Shift:

    Day

    Work Days:

    MON-FRI

    Scheduled Hours:

    9 AM-5:30 PM

    Scheduled Daily Hours:

    7.5 HOURS

    Hourly Rate:

    $29.07

    For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors.

    To learn more about the “Montefiore Difference” – who we are at Montefiore and all that we have to offer our associates, please click here.  

    Family Health Worker: Bronx Health Collective
    This is a 100% grant-funded position. 

    Montefiore Bronx Health Collective (BHC) is a Federally Qualified Health Center located in the South Bronx offering innovative, comprehensive primary care to communities challenged by social inequities and health disparities. We provide care across the lifespan, including primary care for children and adults; prenatal and reproductive health services; specialty referral management; integrated behavioral health; mental health counseling; case management and entitlements assistance; and health education.

    The Community Health Worker Institute at Montefiore is an institute of excellence designed to help patients navigate social determinants of health. Family Health Workers (FHWs) are integrated as critical members of clinical healthcare teams across the health system to help patients identify and navigate clinical and community resources, remain engaged in clinical care, and empower themselves to advocate for their own health.

    This specific FHW role is essential for enabling provider productivity within the HOME Program. The position is responsible for front desk functions, registration, and active field-based outreach—including traveling to mobile units and part-time clinics at local shelters. FHWs are responsible for conducting follow-ups, documenting outcomes, providing support across multiple clinical sites, and traveling weekly as required.

    Key Responsibilities

    • Assess patients’ social needs and link patients to needed services.
    • Follow up with patients to improve engagement, ensure that challenges have been addressed, and needs are met.
    • Conduct intense follow up with high-risk patients to improve clinical outcomes, and articulate patient barriers, risks, and complications to the care team.
    • Share up-to-date resources, eligibility criteria, and other information relevant to navigating health and social needs, including organizing required documents, completing applications, and scheduling appointments.  
    • Conduct home visits (virtual and in person) and accompaniment to service providers for patients/families with the highest needs.
    • Support front desk functions, registration, and operations on mobile units and shelter-based clinics.
    • Track and document patient contacts, services provided, and follow up outcomes.  
    • Build and maintain positive working relationships with social service agencies, community-based organizations, and community-based programs to support social needs navigation.  
    • Effectively convey the role and services of the CHW Institute and CHW staff to internal and external stakeholders, community members, and patients.
    • Complete ongoing training to enhance patient engagement skills, content area knowledge, and navigation.
    • Conduct individually tailored education and follow up to support healthy behaviors and uptake of health and social support services.

    Qualifications

    • High School Diploma or GED required
    • 1–3 years of experience 
    • Bilingual (English/Spanish) required
    • Proficiency with PC computers, Microsoft Office Suite, Electronic Medical Records (Epic), data reporting systems (REDCap), and virtual meeting software (Microsoft Teams, Zoom)
    • Fit Test - OHS Required
    • Annual Assessment - OHS Required

    Montefiore Medical Center is an equal employment opportunity employer. Montefiore Medical Center will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.

    About Company

    About Montefiore Medical Center

    Commitment to Excellence

    As the academic medical center and University Hospital for Albert Einstein College of Medicine, Montefiore Medical Center is nationally recognized for clinical excellence—breaking new ground in research, training the next generation of healthcare leaders, and delivering science-driven, patient-centered care.

    Montefiore is ranked among the top hospitals nationally and regionally by U.S. News & World Report. For more than 100 years we have been innovating new treatments, new procedures and new approaches to patient care, producing stellar outcomes and raising the bar for medical centers in the region and around the world. As we build on this momentum, we continue to advance the practice of medicine and set the standard for excellence.

    Enduring Mission and Distinguished History

    The mission of Montefiore is to heal, to teach, to discover and to advance the health of the communities we serve.

    From its beginning in 1884, as a facility for the care of patients with tuberculosis and other chronic illnesses, to the new millennium, Montefiore has been at the forefront of patient care, research and education and steadfast commitment to its community.

    Our Services

    We provide coordinated, compassionate and leading-edge care designed to reach people when and where they need it most. Through highly integrated teams of physicians, nurses, social workers, mental health professionals and other caregivers, we have created an innovative, seamless system of care focused around the patient.

    Notable Centers of Excellence

    At the intersection of Einstein science and Montefiore medicine is our commitment to scientific inquiry. This commitment has resulted in the creation of the Montefiore-Einstein Centers of Excellence in cancer care, cardiovascular services, transplantation and children’s health, where nationally recognized investigators and multidisciplinary clinical teams collaborate to develop and deliver advanced, innovative care.

    Advanced Specialty and Surgical Care

    We offer advanced, multidisciplinary care across specialties, delivering one standard of excellence for all. Our interventions are designed to help patients understand and manage their illness, advocate for their health, access the right treatments and receive the vital social support they need to flourish. On multiple fronts, Montefiore is developing more effective and less invasive approaches to complex problems from procedures to repair diseased hearts, protocols to treat complex cancers and medical devices designed to meet the needs of growing children.

    Primary Care

    With nearly 50 primary care locations throughout the New York metropolitan area, we are focusing on accessible, patient-centered primary and preventive care provided by leading physicians in the areas of family and internal medicine, pediatrics, obstetrics and gynecology, and a team of experts in nursing, health education, nutrition and pharmacy.

    Providing Care Without Walls

    Montefiore combines its deep commitment to the community with nationally-renowned expertise to reach people in locations easiest for them. Through Montefiore’s School Health Program (MSHP), Primary Care at Home programs, mobile medical and dental health vans and health education initiatives, Montefiore provides primary care services in non-traditional settings.

    Through the formation of highly integrated teams of physicians, nurses, social workers, mental health professionals, care managers and other caregivers, we provide care around the patient, when and where they need it.

    Research and Education

    Montefiore's partnership with Einstein advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Together, the two institutions are among 38 academic medical centers nationwide to be awarded a prestigious Clinical and Translational Science Award (CTSA) by the National Institutes of Health.

    The second-largest medical residency program in the country, with 1,251 residents and fellows across 89 programs, Montefiore provides the doctors of tomorrow a unique opportunity for education and training in one of the most diverse urban areas in the country — one where the population is global, the disease burden is high, and the need for quality care is great.

    The partnership is further strengthened by the dual appointments of faculty and physicians across both organizations—enhancing synergies and collaborations for research, teaching and patient care.

    Comprehensive Care Management

    Since 1996, Montefiore has developed advanced models of care management to help patients, especially those with chronic diseases such as diabetes, heart failure and mental illness, achieve better health and improved wellbeing in a cost effective way. Montefiore goes beyond fragmented fee-for-service payments, assuming total responsibility for the quality and costs of care for some of our sickest patients.

    Through CMO, Montefiore Care Management, we use a global prepayment or similar strategies to manage care for 200,000 individuals over the continuum, including hospital care, rehabilitation, outpatient care, professional services, home care, mental health counseling, community-based services, remote patient monitoring and many other programs.

    Our leadership in coordinating care across multiple settings has earned us federal recognition from the Centers for Medicare and Medicaid Services as a Pioneer Accountable Care Organization. Montefiore's ACO is one of only 32 organizations in the nation, as well as the only one in New York State, to operate under this new model of providing Medicare beneficiaries with higher quality care, while reducing expenditures through enhanced care coordination.

    Learn More

    • Mission, Vision and Values – Montefiore’s unique path of growth into the future and the clinical excellence and outstanding customer care that will get us there.
    • History and Milestones – Proud traditions guiding our mission and the moments that helped shape Montefiore into a premier academic medical center.
    • Commitment to the Community – Community health, education and neighborhood development.
    • Leadership – Executives and clinical chairs leading Montefiore’s advancements.
    • Physicians – Widely acclaimed medical professionals and specialists who provide our patients with the highest standards of care.
    • Nursing Staff – Highly competent and compassionate professionals committed to improving the health of their patients.
    • Ways to Give – Philanthropic opportunities and other ways to support Montefiore Medical Center.