Community Health Worker

Join A Team That Believes Everyone Deserves Care

Candidates must reside within North Lakes' service area at the time of hire and maintain residency throughout employment.

The position's main purpose is to connect people with support and resources to improve overall health and wellbeing. The CHW works with each person to build on their strengths, reduce barriers to care, and improve important aspects of life (financial, safety, physical, emotional, etc.). The CHW plays a key role in our efforts to provide comprehensive and integrated care to all patients.

• Administer assessment of whole-person needs for social drivers of health, including housing, economic stability, social networks and supports, access to healthcare, access to food, stress, wellbeing and safety
• Identifies patients meeting criteria for care management services
• Collaboratively develop a plan based on personal goals, and connect people to resources and supports to achieve said goals
• Provide informal counseling and support, screenings, and referrals
• Establish trusting relationships with patients and their families
• Provide ongoing follow-up, basic motivational interviewing and goal setting with patients/families
• Maintains follow-up care with patients through phone contact and office visits, while at the same time encouraging and fostering self-management
• Connect people to healthcare and social services through referrals, warm hand offs and follow-up
• Keep up to date on community resources and services and how to access them, and facilitate system navigation
• Help people keep appointments, including appointment reminders
• Manage care transitions for vulnerable populations
• Connect people to the Sliding Fee program, North Lakes Care, and other programs
• Assist in completing applications and registration forms
• Conduct eligibility determination, enrollment and follow-up to enroll individuals into health insurance plans, including CAC duties
• Work closely with care team to ensure people have comprehensive and coordinated care
• Act as an advocate and liaison between the person/family and service agencies (i.e. schools, Department Human Services, Heath Care for Homeless, hospitals, support groups, etc.)
• Manage assigned caseload of participants
• Attend regular staff meetings, trainings and other meetings as requested
• Collect program data and relay information
• Record patient care management information in the EMR and other software
• Understand and demonstrate knowledge of HIPAA
• Develop and maintain relationships with organizations and agencies providing health and social services
• Maintain and disseminate updated resource information
• Work with Department Manager to identify community involvement and outreach needs
• Other duties as assigned

· A Bachelor's Degree (B.A or B.S.) preferred, with 1 year of relevant experience in community-based settings

· Position must keep current on information pertaining to community resources and services.

· In-depth understanding of communities served

· Strong psychosocial background

· Relevant experience in case management

· Ability to interact with physicians & other health care professionals in a professional manner

· Strong interpersonal and communication skills

· Adaptable to change

· Proficient in Microsoft Office

· Keeps all matters related to the organization confidential in accordance with HIPAA and the confidentiality policies and procedures.

For full time and part time employees who work 24 or more hours per week we offer a generous benefits package that includes:

• Medical and dental insurance
• Employer paid group term life and disability
• Employer contribution toward Health Savings Account
• Flexible Spending Accounts
• Paid Time Off (PTO), Paid Holidays and Paid Leave Bank
• 403(b) with a 4% employer match

Various voluntary benefits:

• Vision Insurance
• Supplemental Life, AD&D and Disability
• Tuition reimbursement
• Health and Wellness reimbursement program
• Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members
• Partner of HRSA/NHSC loan repayment program

Our Mission is to respond to the healthcare needs…