Certified Community Health Worker -CKD

Schedule: Monday through Friday, 8:00 AM to 5:00 PM (1 - hour lunch)
Compensation : $40,000 - $50,000 a year (May increase based on experience)

Job Summary


The Community Health Worker goes beyond medicine by connecting AbsoluteCare members with resources that help address their social needs and overcome barriers to care. This role fosters trust and builds meaningful relationships with members, meeting them wherever they are, whether at home, in the community, at the hospital, or in an office setting. The Community Health Worker will also reach out to new members, educating them about AbsoluteCare and guiding them through enrollment in both internal and external services. This position operates in a matrixed environment, with dual reporting to the Community Team Care Manager for daily care management and the Engagement Manager/Director for performance evaluation, strategic alignment, and program oversight.


Duties and Responsibilities

• Effectively represent AbsoluteCare, and communicate how ABC's services, programs, and resources, including ABC's PCP clinical care model-can help in the member's specific situation.
• Conduct in-person non-clinical assessments to understand member needs, preferences, and barriers to care, including social determinants of health (SDOH), and evaluate the home environment as needed.
• Create and administer individualized care plans for members, incorporating clinical team input when addressing clinical needs.
• Effectively and efficiently connect members with appropriate AbsoluteCare and community resources such as mental health, substance abuse, housing support, transportation, clothing, food, and other basic needs.
• Authentically build trust and rapport with members, their support systems, and communities to drive engagement.
• Manage a caseload of members, identifying and addressing member needs, enrolling members in appropriate services, and ensuring follow-through on care plans and connections to community and clinical resources.
• Partner with care team (community PCPs, specialists, and internal staff), including attending daily huddles and team meetings, prioritizing members, caseload, and align around actions.
• Document daily outreach activities into care management platforms (e.g., Jiva), electronic health records (e.g., eCW), and CRM systems.
• Meet predefined metrics and KPIs for successful member engagement, social needs resolution, and member enrollment into programs and services
• Support members within the Member Lounge with events.

Minimum Qualifications

• High school diploma or equivalent required.
• Must have a valid driver's license, proof of insurance, and reliable personal vehicle.
• 2+ years of experience working with community agency providing services encompassing the basic competency areas of health care (community resources, communication skills, individual and family advocacy, health education, services skills, and responsibilities).
• CPR/BLS certification required.
• Certified as a Community Health Worker required prior to employment
• Experience and passion for working with and engaging vulnerable, hard to engage, complex populations.
• Independent and persistent self-starter
• Proficient in PC skills, such as Microsoft Office.
• Ability to travel locally at a minimum of 80% of the time.
• Knowledge and trusting relationships within the local community, and experience and knowledge navigating community resources.

Working conditions


This job operates in the community, in members' homes, and in the AbsoluteCare clinical center. This role requires a dedicated, quiet workspace with the ability to adhere to HIPAA and other privacy policies. A reliable and high-speed Wi-Fi connection. This role routinely uses general office equipment. It is required that you have and can use your personal vehicle to conduct outreach including member home visits.


Physical requirements

• Driving and walking in the community where our members live.
• Ability to communicate clearly and exchange accurate information constantly.
• Ability to remain stationary for long periods of time.
• Ability to operate computer, keyboard, copy and fax machine, phone, and other general office equipment.
• Ability to occasionally move objects up to 20 lbs.

Direct reports


None.


All Employees are expected to maintain the security and privacy of all information that is owned by AbsoluteCare or maintained on behalf of the company's patients, employees, and business partners. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. This description reflects management's assignment of essential functions, it does not proscribe or restrict the tasks that may be assigned. This job description is subject to change at any time.

Company Description:

Why Work at AbsoluteCare?


At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into members: people who are entitled to some of the best, most focused care this country has to offer.


We call this "care beyond medicine." We have turned the doctor's office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members' needs. We make the most important services available to our members under one roof. This includes a pharmacy, X-rays, a blood lab, nutrition services, urgent care, and much more.


We don't stop at our four walls. We engage members in the communities where we all live to find the people who need us most. Through these community care teams, we remove the barriers to healthcare that so many people face daily. And it works.


Our unique care is guided by our core values of accountability, caring, trust, and teamwork. We call it ACT2.

AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.