Community Health Worker (Chronic Illness Care Coordination)

Position Summary:

Under the direction of the Director of Care Navigation and Health Promotion, the Community Health Worker (CHW) supports patients with chronic illnesses, primarily diabetes and/or hypertension through individualized education, care coordination, and ongoing follow-up to improve health outcomes. This role helps ensure patients complete recommended appointments, lab work, and supportive services. The CHW will also support UHP's social prescribing/arts for everyone program linking referred patients to arts and wellness resources and supporting on-site arts and wellness events. The position also supports program success through documentation, data tracking, quality improvement, and community engagement activities.

This is a hybrid position with 4 days of onsite and 1 day of remote work per week based in the Bronx.

Minimum Qualifications:

• Associates Degree in Community Health, Health Education, or related field is required.
• Bilingual English/Spanish (required).
• 1-2 years of experience providing patient care.
• Foundational knowledge of chronic health conditions, interest in arts and wellness programming, and dedication to supporting patients.
• As a hybrid role, incumbent must have desk space/work area that can maintain company equipment that may be issued.

Compensation: $46,000-$50,000 per annum based on 40 regular hours of work.

Schedule: Monday to Friday 8:00 am- 5:00 pm

Key Duties:

• Provide individualized education and support to patients with chronic illnesses, primarily diabetes and/or hypertension.
• Ensure patients are being seen by specialty providers as needed and are completing important lab work and other illness related exams.
• Make referrals to support staff such as case management, nutrition, and social work as appropriate and follow up to ensure services are received.
• Schedule continuous follow-up sessions with patients until significant improvement has been made and/or patient is no longer uncontrolled.
• Conduct outreach and engagement to patients who have been referred to our Arts for Everybody program and link them to services.
• Employ motivational interviewing to identify and address barriers to chronic disease management and participation in arts-based activities.
• Support the Arts & Wellness Coordinator during onsite arts programming and participate in organizational health fairs and community events.
• Assist with survey administration, data collection, and preliminary data review related to arts-based programming outcomes.
• Collaborate with clinical providers to promote the social (arts) prescribing program and increase appropriate referrals.
• Submit tracking logs timely and complete documentation as required.
• Participate in quality assurance and quality improvement activities and special initiatives as assigned.
• Perform other duties as needed

About Urban Health Plan:

At Urban Health Plan (UHP) our mission is to continuously improve the health of communities and the quality of life of the people we serve by providing affordable, comprehensive, quality, primary and specialty health care and by assuring the performance and advancement of innovative best practices. At UHP, our commitment to provide patient-centered, holistic, quality health care, is part of a tradition started by our founder, Dr. Richard Izquierdo, more than 50 years ago. That tradition continues today by promoting excellence in everything that we do.


Benefits Include:

• Fully funded Health Insurance for yourself
• 73.5% funded Health Insurance for your family
• Dental Insurance
• $50,000 term life Insurance
• 401(k) Retirement Savings (including annual UHP Contribution)
• Comprehensive time off including paid vacation, personal time, sick time, and paid holidays (including your birthday!).

UHP is an equal opportunity employer. M/F/D/V. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex, sexual orientation, gender identity, gender expression, national origin/ancestry, citizenship status, disability, age, marital or family status, and military or veteran status.

Job Requirements