Community Health Worker

Job Description

Job Description

Community Health Worker About the Role

Are you passionate about making a real difference in people's lives and improving health equity in our community? Lamoille Health Partners is seeking a dedicated Community Health Worker to join our integrated care team.

In this role, you will work directly with patients and their families to identify health goals, overcome barriers to care, and create practical plans for long-term well-being. Serving as a vital link between patients, healthcare providers, and local resources, you will provide care coordination, transitional support, and community outreach—helping ensure everyone in our community has access to the compassionate care they deserve.

Patient Engagement & Care Coordination:

• Meet with patients on-site or in the community using a holistic, patient-centered approach to assess social, emotional, and financial needs.

• Utilize motivational interviewing to build therapeutic relationships, develop self-management plans, and support patients in achieving their personal health goals.

• Provide brief mental health and substance use support, connecting patients with internal/external behavioral health, MOUD, and peer recovery resources.

• Assist post-hospital discharge to ensure smooth transitions and improved health outcomes.

Resource Navigation & Community Outreach:

• Help patients access essential programs, including low-cost medications, Sliding Fee assistance, health insurance enrollment (Vermont Health Connect), and transportation.

• Build strong partnerships with local schools, human service agencies, and community organizations to expand access points for care.

• Actively participate in multi-disciplinary care teams and case reviews to deliver wrap-around support.

Quality & Team Support:

• Maintain accurate, timely documentation within the Electronic Medical Record (EMR).

• Serve as an advocate and educational resource for staff regarding the needs of underserved populations.

• Participate in Patient-Centered Medical Home (PCMH) accreditation activities, quality improvement projects (PDSA models), and departmental initiatives.

• Education: Bachelor’s degree in Human Development, Psychology, Public Health, Social Work, or a related field.

• Experience: 2+ years of experience working with chronic care needs, ideally in a primary care setting.

• Skills & Competencies:

  • Strong understanding of patient-centered engagement and motivational interviewing techniques.

  • Exceptional interpersonal, communication, and organizational skills.

  • Proficiency with electronic health records and office technology.

  • Ability to manage shifting priorities and work effectively under pressure while maintaining a compassionate approach.

  • Unwavering commitment to patient confidentiality and HIPAA compliance.

At LHP, we believe in supporting our employees so they can best serve our community. We offer a competitive compensation package, full benefits , and generous time off to promote healthy work-life balance.