Community Health Worker

The vision of Greater Newark Health Care Coalition (GNHCC) is for all residents of Newark, East Orange, and Irvington to have a fair and just opportunity to attain their highest level of health. GNHCC is also one of four not-for-profit regional health hubs (RHHs) in New Jersey working with both clinical and social service providers to improve patient care and outcomes for Medicaid beneficiaries.

In furtherance of this vision, and role as an RHH, GNHCC plays four key roles: convenes community stakeholders, collects and analyzes data, pilot programs, and advances advocacy and policy.

The role of the Community Health Worker (CHW) is to serve as a link between health and social services by assisting community members with goals and support to overcome health- related barriers, navigate healthcare systems, connect to health and social service support, and provide advocacy to improve health outcomes. This position of Community Health Worker is grant-funded under the New Jersey Department of Health Cardiovascular Disease Prevention Program.

The CHW will be integrated into a multidisciplinary care team to provide support to individuals in Newark, NJ at highest risk of cardiovascular disease (CVD), with a focus on hypertension and high cholesterol.

• Collaborate with multidisciplinary clinical care team at the Rutgers NJ Medical School General Medicine clinic at the University Hospital Ambulatory Care Center (ACC).
• Conduct community outreach, recruitment, and educational activities in targeted census tracts to promote the Rutgers NJ Medical School cardiovascular clinic to assist with connections to clinical care.
• Provide and maintain high-level case management with a minimum of 20 clients requiring complex levels of support and resources. Establish and maintain an active working relationship with community agencies and resources that may benefit individuals with or at risk for cardiovascular disease.
• Conduct regular needs assessments, including assisting clients with setting goals that promote social and behavior change. Make weekly follow-up calls, community and home visits to current and prospective clients. Motivate clients to meet their health and well-being goals.
• Assist clients with goals related to social issues like homelessness, behavioral health, and hunger, and assist clients with organizing their records, making follow-up appointments, and filling prescriptions.
• Help clients fill out applications for benefits like insurance and food supplements.
• Utilize a technology platform to document every client encounter in detail in a timely manner.
• Prepare reports and documents as needed or requested.
• Attend regular team meetings with the Rutgers University team and with GNHCC staff as required.
• Attend ongoing training and professional development as required.
• Work with other CHWs in the region to optimize CHW supports.
• Adhere to the GNHCC policy and procedures in professional development and conduct.
• Other duties as assigned.

• Knowledge of and willingness to learn about cardiovascular disease prevention, including hypertension and high cholesterol, and the role of health-related social needs in driving outcomes.
• Demonstrated ability to communicate and collaborate across multidisciplinary clinical and community settings, particularly on behalf of medically and socially vulnerable populations.
• Strong case management and client navigation skills, including support with complex needs in nontraditional and community-based settings; experience in urban environments and familiarity with Newark preferred.
• Ability to conduct needs assessments, goal setting, motivational interviewing, and follow-up to support behavior change and adherence to care plans.
• Knowledge of and ability to connect clients to community resources and benefits services, including Medicaid, SNAP, insurance enrollment, housing, food, and behavioral health supports.
• Demonstrated cultural humility and ability to work effectively with individuals of diverse ages, backgrounds, ethnicities, and life experiences.
• Exceptional organizational, time management, and administrative skills, including accurate documentation,…