Community Health Worker

This is a Hybrid role where applicants should reside within 30 minutes from Winnemucca, Nevada. Schedule is 9:30AM-6:30PM Monday-Friday.

At Activate Care, we’re on a mission to improve health equity and drive improved health outcomes across the country. Our Community Care Record platform enables healthcare and community organizations to coordinate care for populations challenged with health-related social needs. Path Assist is our tech-enabled community health worker program for HRSN utilizing an evidence-based, structured intervention. Our goal is simple: increase health confidence, improve self-efficacy, and reduce inappropriate healthcare spend.

Activate Care is teaming up with Care Source, and we're hiring a hybrid, Care Coordinator located in Nevada, who will play a key role in supporting the screening, assessment, and care navigation for local Nevada community members enrolled in the Path Assist program. This role will be both work from home, and require commuting in the field or local designated area.

This is an exciting role that will help accelerate local change happening in your state to drive toward better and more equitable community health.

• Have a passion for and experience working with individuals and families to make sure they have the knowledge, support, and resources needed to meet their social and health needs.
• Have experience successfully creating client or patient-centered action plans with community members and connecting them to services and resources from local nonprofits and social service organizations.
• Have a deep understanding of how to navigate barriers that individuals face when attempting to access community-based services or support.
• Are a self-starter who can operate independently with minimal supervision and think creatively to solve problems.
• Detail-oriented and focused on the delivery of the program model as designed.
• Thrive in a fast-paced hybrid work environment that is constantly changing by operating with a high level of autonomy/self-direction.
• Have experience utilizing electronic platforms to document patient or client care and interactions, adhering to excellent data collection standards.
• Curious and committed to developing strong relationships with resources in your community to improve the success of client referrals.

• Provide care coordination and resource navigation to an assigned caseload of community member clients with unmet social needs.
• Conduct consistent telephonic and face-to-face outreach, follow-up, and coaching to members to assess needs, provide education, and assist with enrollment in eligible services/benefits/programs.
• Administer social determinants of health (SDOH) screening, intake forms, and any needed assessments in the Activate Care platform.
• Assist clients with prioritizing goals and creating client-centered care plans.
• Coordinate with community nonprofits and resources to help clients meet their needs.
• Provide resources to clients to improve their health literacy and self-sufficiency.
• Coordinate healthcare transitions by leading outreach and follow-up for members post-hospital discharge or ER visits and collaborating with providers and families to ensure continuity of care and prevent readmissions.
• Navigate complex care environments by coordinating member care across multiple healthcare settings while facilitating referrals to specialty or behavioral programs as needed.
• Support Medicaid and health plan navigation by partnering with health plan teams to support service authorizations, help members understand their benefits/appeals, and advocate for their care coordination needs.
• Engage vulnerable populations by providing person-centered coordination for high-risk members experiencing housing instability, complex medical conditions, or other acute social barriers to care.
• Take a proactive approach to assist with assigned cases (e.g. help schedule appointments, complete applications, make reminder calls, etc.)
• Maintain client privacy and uphold confidentiality at all times.
• Participate in weekly team meetings, workshops, and training to expand knowledge of department priorities, while remaining current on new developments, as required.
• Ability to commute to and from client’s homes and field locations as required.
• Other duties as assigned.

• Degree requirements:
  Candidates should possess a minimum of a high school diploma or equivalent.
• Must have a valid driver's license in the state of Nevada.
• Must be able to use personal vehicle to commute to and from clients' homes.
• 2-3 years of relevant work experience providing direct care coordination services to individuals and families (preferred).
• Experience working directly with nonprofits, social service providers, faith-based groups, or government agencies that address social determinants of health.
• Exceptionally strong independent working skills with strong communication.
• A collaborative team player who is…