Community Health Worker - RCCC

Health Care Access Maryland (HCAM) is a nonprofit organization dedicated to making Maryland healthier by connecting residents to health insurance coverage and providing comprehensive care coordination. Each year, HCAM assists over 80,000 individuals across the state, offering personalized guidance, health education, and advocacy to ensure every Marylander has an equal opportunity to achieve optimal health.

The RCCC Community
Health Worker (CHW) is responsible for providing outreach, social support, care transition, and community resource information to soon release clients and their families. The Community Health Worker serves as a bridge for returning citizen clients, the corrections clinical care team, and the community to address health-related social needs with the goal of reducing recidivism and emergency room use. CHW will provide care coordination services for the client/participant for an approximate 90-120 day period, maintain a caseload of 50-70 individuals at a time.

The CHW will schedule appointments, accompanying as needed, educate and link to community resources and refer clients to local social service agencies. Additionally, the CHW will assist with completing forms and applications for benefits and community resources, coach clients on self-management, conduct community home visits, and ensure the client has active medical insurance coverage. The RCCC CHW will serve individuals serving and being released to Baltimore County, Baltimore City and Anne Arundel County.

• Participation in professional development opportunities that build skill in areas of client engagement and intervention, motivational interviewing, and trauma-informed outreach strategies.
• Participation in all internal and external meetings, conferences, seminars, workshops
• Complete the DPSCS Clearance training to access Maryland State Institutions.
• Must work on-site within the DPSCS institutions and work directly with clients face-to-face related to program enrollment questions and concerns.
• Respectfully communicate in a timely manner with the supervisor.

• Initiate client outreach via telephone or via home visit within 2-3 days of receipt from the referral coordinator to conduct social needs screenings and health risk assessments prior to the clients release from custody.
• Provide health education to uninsured clients about available health insurance programs; assist them in choosing an MCO and identifying a primary and dental medical provider, behavioral health and substance use provide if applicable.
• Refer clients to relevant programs that can further support them in Anne Arundel County, Baltimore City, Baltimore County, or any other Maryland districts as needed.
• Connect and collaborate with Providers, Discharge Planers, Re-Entry Coordinators, Social Workers, Community Based Organizations, MCO Case managers and other professionals to address and resolve client need.
• Participation in all DPSCS Resource Fairs and other community outreach events and activities.

• Pre-release, work on-site within the DPSCS institutions, meet clients face-to-face related to program enrollment.
• Post-Release, visit with clients in various settings including but not limited to at home, transitional houses/recovery houses, HCAM offices or other facilities as agreed upon by the Community Health Worker and client.
• Connect with the client within 48-72 hours after release to provide hygiene kit and establish care plan.
• Connect with clients on a weekly basis for up to two months post release, and monthly thereafter for up to 12 months to provide ongoing assistance and linkage to care and services.
• Assess, enroll, and refer clients to a variety of available resources to reduce barriers to care.
• Empower clients to engage, stay engaged, re-engage with community service by using motivational interviewing techniques to engage and coordinate care/services to clients.
• Follow HIPAA, confidentiality, and mandated reporting to the appropriate authority representative, in cases of abuse, neglect, or imminent danger.
• Maintain a monthly minimum success rate of 70%.
• Maintain a monthly minimum on-time case closure rate of 80%.

• Documentation of all outreach activities according to standard operating procedures in the HCAM electronic medical database.
• Documents client assessments, activity, service plans and resolutions; prepare narrative and statistical reports.
• Provide…