Community Health Worker

Community Health WorkerThe Community Health Worker (CHW) works closely with medical providers, primary care teams, and social services agencies to provide short term care coordination. The CHW assists with connection to resources and support to program patients to improve their health and general well-being through education and provision of coordination of care and services. Community outreach, such as home visits, health screenings and events may be required.This position reports to the Director, Patient Centered Services & Outreach and Co-Director of Patient and Community Engagement. No other positions report to this position.While living and demonstrating our Core Values, the Community Health Worker will:Understand what it means to be the following: A Federally Qualified Healthcare Center (FQHC), A Patient Centered Medical Home (PCMH), Recognized as a National Committee for Quality Assurance (NCQA), Participant in an Accountable Care Organization (ACO)Assist patients in their homes, community, or health center settingCommunicate to patients the purposes of the program and the impact it may have on their wellbeingHelp patients identify socio-economic issues that affect their overall health and develop health/social management plans and goalsDocument patient encounters and contacts made on behalf of patients in EMR; completes and submits monthly reports; maintains comprehensive electronic patient files, which include patient notes, release of information, assessments and other medical documents acquired on behalf of the patient.Educate patients on the proper use of the Emergency Department and provide information for alternatives. Coach patients in effective management of their chronic health conditions and self-care. Assists patient in understanding care plans and instructionsMotivate patients to be active and engaged participants in their health and overall wellbeing. Connects with Hot spotting Teams to connect patients with enabling servicesProvide support and advocacy during initial medical visit or when necessary to assure patients' medical needs and referrals required are being conveyed. Follow up with both patients and providers regarding health/social services plans. May be required to go to hospital as needed.Continuously expand knowledge and understanding of community resources and services Facilitate patient access to community resources, including locating housing, food, clothing, prenatal classes, parenting, and relevant mental health services. Assist patients in utilizing community services, including scheduling appointments with social services agencies and assisting with completion of applications for programs for which they may be eligibleFacilitate communication and coordinate services between providers and the patients. Coordinate and monitor services, including comprehensive tracking of patients' compliance in relation to care plan objectivesWork collaboratively and effectively within a team. Establishes positive, supportive relationships with participants and provides feedback to other members of the team. Build and maintain positive working relationships with the patients, providers, care managers, medical residents, and office staff. Work to reduce cultural and socio-economic barriers between patients and institutionsProvide self-pay patients with options to pay for servicesEnsure patients understand health center resources and available programs, such as Sliding fee discount program, Good Faith Estimate (GFE), Outreach & Enrollment programs, Language services, After hours coverageEnsure compliance in the following areas: Availability and location of SDS binder, Availability and location 990 binders for all TWC entities, Understanding role and responsibilities in an emergency to help coworkers and patients to safetyDemonstrate positive working relations with patients, visitors, and staff to effectively communicate The Wright Center's missionAttend weekly huddles and morning/afternoon mini huddlesParticipation in rotation of extended access hours including late nights, weekends and holidaysCross coverage of other locations and service lines for continued support and access for patientsUnderstanding of multiple insurance dynamics including copays, coverage, navigationObtain and maintain the Pennie Assister training certification to outreach and enroll patient in the appropriate insurance within 90 days of employmentCommitment of outreach and engaging patients with positive PCRT screenings and outstanding barriers to carePlay key role of capturing patient demographic information needed, especially barriers to care to help provide overall picture of patient populationPerform miscellaneous job-related duties as assignedRequirementsMeet The Wright Center for Community Health and its affiliated entity The Wright Center for Graduate Medical Education EOS© People Analyzer ToolBuy in and experience working in the EOS® model (strongly preferred)Mission-oriented; represents the enterprise in a professional manner while demonstrating organizational prideHigh school diploma or GED; at least 3 years of experience directly related to the duties and responsibilities specifiedCurrent BLS certificationCompleted degree(s) from an accredited institution preferredComplete AHEC training for CHW certification within one year of employmentMust apply for the CCHW PA certificate after completing the CHW training and within thirteen (13) months of hire, must obtain the certificate within 15 months from the date of hireBilingual highly desiredStrong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse communityKnowledge of community agencies and resourcesWorking knowledge of patient centered medical home model and multi-system outreach programs related to health care delivery, clinical education, and health-related servicesAbility to plan, implement, and evaluate individual patient care plansKnowledge of transportation and other barriers to care that may be encountered by patientAbility to communicate medical information to health care professionals and care coordinators over the telephoneBasic computer skillsSkill in organizing resources and establishing prioritiesCreative and analytical thinking