Community Health Worker
7 days ago
Summary:
Under the direction of the ECM Director, The Community Health Worker (CHW) will work closely with ECM Lead Care Manager, Managed Care Coordinators, Case Managers, Outreach Team, providers, and local Community Services (CS) and homeless service providers to improve outreach and engagement, as well as coordination of patient care for ECM eligible populations.
The CHW will assist the ECM team in developing a patient centered outreach plan, provide appropriate outreach, identify client needs, and direct them through the appropriate administrative system and patient support services.
The Community Health Worker will be engaging with and developing relationships with at risk for and/or homeless individuals with a variety of needs, including but not limited to, chronic health conditions, substance use and abuse, behavioral health issues and other social service referrals and linkages.
The Community Health Worker performs outreach, community health work and housing linkage services.DUTIES AND RESPONSIBILITIES:
- Collaborates with ECM team to assess member touch points, such as local ER departments and hospitals, shelters, and food banks.
- Collaborates with ECM team to provide appropriate outreach based on touch point assessment and implements outreach strategies for working with and developing relationship with ECM eligible individuals.
- Conducts community outreach and engages with individuals to inform them of our program and services and encourage participation. Community outreach includes, but is not limited to street, home, hospital, and other settings outside of Arroyo Vista.
- Follows Arroyo Vista Safety Protocols especially when conducting field community outreach.
- Works with ECM patients to obtain verbal and formal consent to participate in ECM.
- Conducts conversations with clients/visitors to determine information and service needs.
- Assists clients from diverse cultural backgrounds in understanding the Health System in terms of access and limits to services.
- Maintain communication with clients, ECM team, providers, and local providers.
- Serve as a liaison between clients and clinical staff. Advocate on behalf of Members with health care professionals
- Attend and provide Health promotion and selfmanagement trainings. Distribute health promotion materials.
- Use motivational interviewing, trauma
- Monitor treatment adherence (including medication)
- Assist clients with completion of forms, enrollment into ECM, and enrollment into CS and other community based services.
- Provides a warm hand off to ECM Lead Care Manager and/or PCMH team.
- Maintains and records all outreach activities in the Care Plan.
- Assists with clerical duties such as intake and assessment, making appointments, following up on noshows, managing enrollment and eligibility data for ECM reporting.
- Participates actively in team huddles and meetings with ECM care team.
- Assists in providing interested individuals access to a variety of CS and community based services, which include and are not limited to transportation, food and housing services.
- Maintain uptodate database of CS and community based resources for ECM team and other Arroyo Vista case management teams.
- Provide information on ECM services, clinic services, and health awareness.
- Educate clients regarding available benefits and provide warm hand off to Case Manager.
- Works closely with the outreach team in greeting/receiving new clients and assisting with the intake process.
- Conducts facetoface and virtual community outreach.
- Coordinates patient transportation with Lead Case Manager to needed services, and accompany ECM Member to office visits, as needed, and in the most easily accessible setting, within MCP guidelines
- Attends general staff meetings.
- Other relevant tasks as assigned.
KNOWLEDGE, SKILLS AND ABILITIES
- Strong documentation skills.
- Ability to multitask and prioritize when needed.
- Ability to independently seek out resources and work collaboratively.
- Ability to develop and maintain good working relationships with staff.
- Ability to use computer and learn new software programs.
- Excellent interpersonal skills reflecting clarity, diplomacy, cultural competency and the ability to communicate accurately and effectively with all levels of staff and management.
- Demonstrates ability to work in a regulatory climate that includes oversight of state and federal entities, payer contracts etc.
- Possesses ability to communicate effectively, both verbally and in writing.
- Proficient knowledge of Microsoft Outlook, MS Word, and Excel.
- Able to travel and attend professional meetings, conferences, trainings, and clinic sites.
- Performs other related duties as assigned.
REQUIREMENTS:
- High School Diploma; Associates Degree or higher education in health care and/or social services field preferred.
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