Community Health Worker - Pathways​/MSS

Sea Mar Community Health Centers, a Federally Qualified Health Center (FQHC) founded in 1978, is a community-based organization committed to providing quality, comprehensive health, human, housing, educational and cultural services to diverse communities, specializing in service to Latinos in Washington State. Sea Mar proudly serves all persons without regard to race, ethnicity, immigration status, gender, or sexual orientation, and regardless of ability to pay for services.

Sea Mar's network of services includes more than 90 medical, dental, and behavioral health clinics and a wide variety of nutritional, social, and educational services. We are recruiting for the following position:
Sea Mar is a mandatory COVID-19 and flu vaccine organization. Job Title Pathways Community Health Worker

The Community Health Worker (CHW) will work in and according to the training provided by the Pathways Model to eliminate or mitigate barriers to health and social services as identified through the client assessment. This position will work with clients that meet the criteria established by the local HUB. The CHW will serve as an advocate and link, connecting patients to appropriate community resources and services within the local HUB.

The CHW will provide services in the home, community and office. CHW will document all client interventions and services provided. This is a results-oriented program and success will be measured by the completion of checkpoints within the established Pathways, and improved client self-efficacy and health care outcomes.

• 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…