Community Health Worker

* Work primarily out in the community, where she/he can more readily reach and be accessible to the patients.
* Be a patient advocate.
* Conduct standardized patient in-take and risk assessments.
* Based on the assessment, work to complete the assigned Pathways in a timely manner.
* Document all interactions and assessments in a timely manner, using Pathways documentation platform and Sea-Mar’s EHR.
* Attend trainings and meetings by/for Pathways, Sea-Mar Community Health Centers, and other entities as assigned.
* Establish a trusting relationship with the target population, referred clients, and community partners.
* Identify and assist clients with client identified health and social service goals as appropriate.
* As appropriate, act as a cultural liaison between the health and human service system(s) and clients. Where appropriate communicate clients’ cultural preferences and needs with health and human service system(s), community partners, etc.
* Assist in the development of strategies to address or eliminate barriers to care.
* Work collaboratively with the Program Manager, PCP, and other assigned personnel to make sure that all relevant client needs are identified and addressed.
* Collaborate with HUB partners to identify high-risk clients and assist in the coordination of care with Sea Mar Community Health Center and with other community partners and service providers.
* Demonstrate a commitment to the mission, vision and goals of Sea-Mar Community Health Centers including the ability to integrate Core Values of Community Health Workers as defined by the American Association of Community Health Workers:
Access, Acceptance, Advocacy, Excellence, Learning, Partnership, Social Justice, Strength, Trust and Unity.
* Participate in ongoing assessment of the client and family needs to determine if expected outcomes are reached and to ensure implementation and/or adjustment of the service plan.
* Providing ongoing follow-up on treatment on PCP plans utilizing basic motivational interviewing and goal setting with clients/families.
* Follow-up with clients via phone calls, home visits and visits to other settings where clients can be found.
* Assist clients with completing applications and registration forms.
* Refer uninsured clients to an insurance Navigator/CSR to conduct eligibility determination, enrollment and follow-up.
* Help clients set personal goals, identify and overcome barriers to attending appointments (such as transportation and childcare).
* Provide referrals for services to community agencies and partner with other agencies as appropriate.
* Help clients connect with transportation resources and conduct appointment reminders to ensure patients are keeping their appointments and meeting their goals
* Attend regular staff meetings, trainings and other meetings as required.
* Maintains a caseload of up to 45 clients.
* Completes at least 8 successful contacts per day. This includes patient contacts, family/ caregiver contacts, and hospital contacts.
* Documents on all activities performed with patients within 48 hours. Files will be audited on a regular basis to ensure compliance with Sea Mar policy and requirements of the Pathways funders.
* Completes monthly reports detailing caseloads, statistics, and outcomes.
* The Community Health Worker must be a recognized and trusted member of the community she/he is serving and  + Have the ability to communicate effectively verbally and in writing and utilize good listening skills.  + Ability to be an effective team member and be trusted to work independently.  + Maintain a clear understanding of the Federal, State, and community resources available.  

+ Provide unbiased and accurate education and/or referral(s), even if the clients’ needs might be in conflict with personal viewpoint/belief system of the CHW.  + Be computer literate and able understand how to use the CCS Platform in an efficient manner.  + Demonstrate the ability to recognize potentially dangerous situations to self in the clinic, office, home and community settings and to take appropriate action.  

+ Be Knowledgeable of child/ dependent adult abuse/neglect and mandated reporting law RCW.
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