Community Health Worker- Public Health Nursing

Community Health Worker
- Public Health Nursing

225 S Bluff St, Winnebago, NE 68071, USA

Job Purpose & Position Overview

The purpose of this position is to provide culturally responsive outreach, education, care coordination, and support services for community members living with or at risk for diabetes and other chronic diseases. The Community Health Worker will serve as a bridge between community members, healthcare providers, and community resources to improve health outcomes and reduce health disparities.

Specific Job Duties/Responsibilities:

• Demonstrate the Public Health Department's core mission, vision and values
• Home visit assigned clients as scheduled by PHN Director.
• Assist with medication needs and translation.
• Provide transportation to and from Twelve Clans Unity Hospital and WPHD Programs.
• Provide supervised home health care for assigned clients, and will include:
• Blood pressure/blood glucose monitoring.
• Educate on healthy lifestyle habits.
• Refer to resources as necessary for any Indigenous Social Determinants of Health
• Maintain records and reports as necessary to supervisor.
• Follow-up on at-risk community members.
• Notify patients of scheduled doctor appointments.
• Follow-up from internal staff and referred provider appointments.
• Assist with infections disease screenings.
• Attend all in-service and classes that are health related when possible.
• Attend mandatory training.
• Prepare monthly reports and submit to supervisor.
• Complete patient charting in a timely manner.
• Responsible for maintaining GSA vehicles at all times.

SPECIALTY AREA – Public Health Nursing

• Conduct home visits in collaboration with Public Health Nursing staff to support individuals and families with identified health needs.
• Assist clients with medication management activities, including medication reconciliation, medication reminders, medication education, and identifying barriers to medication adherence.
• Monitor and report medication concerns, side effects, and adherence challenges to the Public Health Nurse.
• Support clients with organizing medications using approved pill organizers and medication schedules under nursing guidance.
• Assist with care coordination for clients with chronic diseases, complex medical conditions, and multiple healthcare providers.
• Conduct follow-up visits and phone calls for high-risk clients after hospitalizations, emergency department visits, and specialty care appointments.
• Provide health education regarding chronic disease prevention and management, including diabetes, hypertension, cardiovascular disease, respiratory disease, and obesity.
• Assist with blood pressure, blood glucose, weight, pulse oximetry, and other approved screenings and monitoring activities.
• Support Public Health Nursing initiatives related to communicable disease follow-up, immunization outreach, maternal-child health, elder services, and health promotion activities.
• Identify and address barriers related to Indigenous Social Determinants of Health, including transportation, housing, food security, access to healthcare, and social support.
• Assist clients with scheduling and attending medical, behavioral health, specialty care, and public health appointments.
• Coordinate referrals to community resources and assist with follow-up to ensure services are received.
• Assist with home safety assessments and identify potential health and environmental risks within the home.
• Support development and implementation of individualized care plans under the direction of the Public Health Nurse.
• Maintain accurate documentation, client records, and reports.
• Participate in case conferences, multidisciplinary team meetings, quality improvement activities, and program evaluation efforts.
• Assist with community outreach, wellness events, health fairs, vaccination clinics, and public health emergency response activities.
• Promote culturally grounded, trauma-informed, and strengths-based approaches to care while supporting Indigenous ways of knowing, being, and healing.
• Attend required trainings, certification courses, workshops, and department meetings.

Required Qualifications /

Skills:

• High School Diploma or GED is required.
• Must possess a valid driver’s license and…