Family Health Worker W (JR233077)

Introduction To heal, to teach, to discover and to advance the health of the communities we serve. To learn more about the “Montefiore Difference” – who we are at Montefiore and all that we have to offer our associates, please click here . Overview The Community Health Worker Institute at Montefiore Einstein is a new Institute of excellence designed to help patients navigate social determinants of health. Family Health Workers (also known as Community Health Workers) will be integrated as critical members of clinical heath care teams across the health system. FHWs are passionate about helping patients overcome challenges, advocate for themselves, and remain engaged in clinical care. The FHW will help patients identify and navigate clinical and community resources, like resources for food (e.g. Supplemental Nutrition Assistance Program (SNAP)/WIC/Food pantries); resolving housing quality issues like lack of heat/hot water, mold and pests; finding and applying for affordable housing; helping preventing utility shut offs and evictions; or connections to other members of the healthcare team or healthcare services. He/She will be responsible for conducting follow up, documenting and reporting on patients’ outcomes. FHWs will be responsible for providing support for patients at multiple clinical sites and be required to travel to each site weekly. 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. Articulate patient barriers, risks and complications to 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 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 home visits (virtual and in person) and accompaniment to service providers for patients/families with the highest needs. Conduct individually tailored education and follow up to support healthy behaviors and uptake of health and social support services. Requirements High School Diploma or GED Required 1 year of work experience Required PC Computer: Microsoft Office Suite, Electronic Medical Record (Epic), Data reporting system (REDCap), virtual meeting software (Microsoft Teams, Zoom) Fax Machine Telephone Photocopier/Scanner #J-18808-Ljbffr Montefiore Hudson Valley Collaborative