Community Health Worker
2 weeks ago
**About NYC Health + Hospitals**:
**Empower Every New Yorker — Without Exception — to Live the Healthiest Life Possible**
NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city’s five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible.
At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.
Under the direction of a Community Health Worker (CHW) Program Manager and as part of the NYC H+H Public Health Corps, Asthma/COPD CHWs work with adult and pediatric patients in primary and specialty care performing patient-centered, community health work in collaboration with interdisciplinary teams in NYC H+H primary care and specialty care clinics, reporting to Ambulatory Care Leadership at each site. CHWs are specially trained frontline public health workers who are trusted members of and/or have an unusually close understanding of the communities they serve. The CHW participates in community outreach activities within the communities of NYC, engaging patients and providing resources and assistance needed to tackle issues preventing them from staying healthy. The CHW motivates and supports individual patients to achieve their health goals in many ways, such as facilitating connections to primary and specialty care clinics, creating health goals, and helping them find affordable healthy food options.
General tasks and responsibilities will include:
- Participate in ongoing education and specialized training to learn and maintain CHW skills, as well as public health emergency response skills, relevant for the Public Health Corps
- Recruit eligible patients and conduct clinical or community-based assessments and interviews to identify their health goals and needs
- Assess and address health, social and service-related needs of assigned/identified patients and create individualized, patient-centered, goal-directed care plans for each patient
- Support and motivate patients to achieve their health goals by coaching them through behavior change and identifying their strengths and community supports
- Help patients connect to a primary care provider, specialty care providers, community services and/or mental health services, attend medical appointments, and fill prescriptions
- Join patients during medical appointments and hospital stays as needed; communicate with their care team to help coordinate care
- Assess ability of patients to manage their chronic disease(s) and work with care team to connect them to appropriate education and monitoring programs
- Educate patients on available community services, health services, and patient rights; provide feedback from patients to NYC H+H to inform quality improvement efforts
- Collect and track data to support achievement of patient-centered care plan using assessment tools, surveys, and logs, as appropriate
- Document each patient encounter in the electronic medical record (Epic) and use other electronic systems (including but not limited to NowPow) in accordance with established policies and procedures
- Attend regular team meetings to discuss patient progress and update care plans; communicate with patients’ primary care providers.
- Conduct home and community-based visits to assess patient needs specific to the home environment
- Review Asthma Action Plan, administer the Asthma Control Test and provide Asthma/COPD education
- Serve as a liaison between the community and the health system by communicating patient experience to the CHW Supervisor and Program team
- Report regularly to CHW Program Manager for support and feedback; participate in program improvement efforts
- Perform other, related CHW program tasks, as needed and perform duties in response to public health emergencies, when necessary
**Minimum Qualifications**:
1. One year of full-time experience in a government agency or community organization in providing community services to the public or in assisting members of the community in obtaining community services; or
2. Completion of an approved six month training program of combined classroom training and on-the-job experience in community liaison work, plus six months of full-time experience as described in 1 above.
In addition to meeting the qualification requirements of Assignment Level I, appointment to Level II requires:
1. Two additional years of full-time experie
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