Community Health Worker

1 month ago

Claymont, United States Aledade, Inc. Full time
Location: Community Health Worker

Position: Henrietta Johnson Medical Center

Definition: Henrietta Johnson Medical Center is a Federally Qualified Health Center (FQHC) with locations in Wilmington and Claymont Delaware. Henrietta Johnson Medical Center will embed Community Health Workers (CHW) within their catchment area to reach some of Delaware's most vulnerable residents. Under the direct supervision of the Chief Operating Officer, the Community Health Worker will work to connect residents to community resources and to employ interventions designed to address Social Determinates of Health. Using innovative, creative, and culturally sensitive strategies CHWs will engage community members through outreach, education and patient interventions and promote individual, family and community wellness. CHWs will strive to build social capital, or social cohesion, within communities by identifying and leveraging respected members and elders who are influential in reaching target populations. These respected members will help identify social networks that can be leveraged to promote health and prevent disease and will work with clients and their families to increase access to medical and/or social services and enhance self-sufficiency. The contractor will work in collaboration with the Division of Public Health and the Delaware Community Health Worker Association to accomplish the following goals and objectives.

Team Philosophy Statement: The Henrietta Johnson Medical Center provides affordable access to integrated and coordinated family practice, women's health, dental and behavioral health care services to the entire family under one roof. We operate with a team of caring, competent, and productive providers and staff who focus on quality, compassionate, and coordinated care in order to provide outstanding service to patients and families. Our staff place a high value on teamwork. They must accept changing duties, be multi-skilled, and perform a variety of tasks in the care of our patients. Each member of the team is dedicated to continuous learning, and contributes toward our goal of providing outstanding health care services to our patients.

Working Conditions: This position is an hourly position, and the incumbent is regularly scheduled to work forty (40) hours per week, distributed over the medical center's usual hours of operation. However, it can be anticipated that some assignments will necessitate extended hours.

Priority Population:

Community Health Workers will focus on assisting individuals who:

1. Reside in census tract with a social vulnerability index of 0.75 or greater

2. Reside in a rural area

3. Are a racial or minority background

4. Have a household income at or below the Federal poverty level

5. Individuals who are in Asset Limited, Income Constrained, and Employed (ALICE) households

6. Report their general health is fair or poor

7. Are non-English speaking or speak predominantly in a language other than English

8. Face barriers to care including level of health literacy or transportation

9. Are referred by a physician or other healthcare providers

HIPAA Statement: The individual will have access to the patient records. Professionalism and confidentiality must be maintained at all times.

Qualified applicants must have:
    • CHW Core Competency certification is required (trained during employment)
    • High school diploma, GED or suitable equivalent
    • 2+ years of work experience in community health or related fields
    • Proficient knowledge of medical terminology, billing practices and coding
    • Knowledge of available State and Federal Grant programs available to Henrietta Johnson Medical Center
    • Proficient computer skills
    • Proficient with MS Office Suite
    • Excellent communication skills, both verbal and written
    • Outstanding people skills
    • Strong organizational skills
Major Responsibilities:
    • Community Health Worker will be embedded in Henrietta Johnson Medical Center's catchment area to serve clients residing in census tracts with a high Social Vulnerability Index.
    • CHWs will support the public health response to COVID-19 among priority populations within communities by identifying and working with those disproportionately impacted by health disparities and have underlying health conditions that increase COVID-19 risk
    • Increase utilization of community resources that address patient/client Social Determinant of Health needs for those at highest risk for poor health outcomes among priority populations within communities by providing cross-sector referrals to other CHWs of partnering community-based organizations.
    • Coordinate with clinical care teams, to support, and follow-up/case-manage/track patient/client outcomes
    • Ensure equitable access to critical resources available to address and support the social determinant of health needs of individuals in census tracts with a high Social Vulnerability Index (SVI)
    • Community Health Workers will receive training on how to access resources and funds designed to address the social determinates of health and improve the overall health outcomes among priority populations by attending monthly Roundtable Meetings of the Community Health Workers Association of Delaware (the second Wednesday of every month, 9:30am-11:00am).
    • CHWs will [have] completed the identified CHW 80-hour core competency training and received a certificate of completion
    • CHWs will attend and complete at least (1) additional core-competency training per quarter (provided by the CHWA, every 3rd Wednesday of each month, 12pm-1pm)
    • Henrietta Johnson Medical Center CHWs will provide (1) presentation to the Community Health Workers Association of Delaware membership at large during a scheduled Roundtable meeting, describing and summarizing the organization's own resources and services provided available to client communities designed to address and improve the overall health outcomes among its priority populations
    • Ensure that individuals working with a CHW who receive aid will have improved short, intermediate, and long-term health outcomes
    • In collaboration with the Population Health Bureau's Epidemiologists, evaluate the short, intermediate, and long-term outcomes of clients who work with CHWs.
    • In collaboration with the Division of Public Health's Population Health Bureau and Community Health Worker Association of Delaware, provide information to legislators, key stakeholders, and community members on the impact Community Health Workers have on census tracts with a high SVI
    • Work with the CHW Pathway Community HUB (PCH), once established, to track the progress of individual clients, to avoid duplication of services, and address structural barriers in real time
    • Participate in trainings provided by the PCH, and the Delaware Division of Public Health's Population Health Bureau
    • CHWs will receive technical assistance from the Pathways Community HUB as needed
    • CHWs utilize tools designed by Community Pathway HUB including but not limited to: o Evaluation tools o Demographic Profile/ Initial Checklist o Visit Form o Progress Form o Care plan requirements for pathways o Standards for a completed pathway and the discharge of clients once identified needs have been addressed
Deliverables and Performance Measures:
    • The contractor will be responsible for collecting and submitting monthly reports which will be developed by the Division of Public Health Population Health Bureau
    • The contractor will administer screening tools to identify needs associated with the social determinants of health and facilitate access and information to services and resources to address such needs
    • The contractor will administer a post-test on the status of the SDOH
    • The CHWs will apply for and be a member of Delaware Community Health Worker Association.
    • CHWs will attend monthly contract check-ins the Division of Public Health's Social Service Administrator
    • The Contractor and/or CHWs must track progress towards deliverables utilizing a reporting tool developed by the CHW in collaboration with DPH staff. Reports for the previous months are to be submitted with monthly invoices no later than the 15th of the subsequent month
    • The Contractor must use the invoice template and monthly reporting spreadsheets provided by DPH. Adding an agency logo to the forms is acceptable. Adding additional agency-specific documentation to the patient file is acceptable


Please note this position is posted on behalf of our partner practices. This individual will be working at the specific practice that is mentioned in the above details and will not be a direct employee of Aledade, Inc. so will therefore not be eligible for the benefits available to Aledade employees.

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