The Community Health Workers (CHWs) work alongside medical professionals in a clinical care team. As a member of the healthcare team, the CHW serves as an advocate for patients during medical appointments, will assist with healthcare navigation and address social determinants of health (SDOH) needs to improve the patient experience and improve clinical outcomes The CHW serves as a resource person for staff and models a commitment to the organization’s vision/mission/values to support an unparalleled patient experience and positive clinical outcomes.

The CHW may work onsite at a primary location or multiple locations based on business needs.

Essential Duties
• Collaborates with the patient’s care team including primary care team, specialists, home care, hospital team, and any others involved with the patient’s care to optimize clinical outcomes.
• Works as a team member, interacting with staff, patients, and providers to communicate and coordinate patient care and workflow effectively.
• Serves as an advocate, providing direction and support to the patient and family.
• Interfaces with providers and clinic team to ensure that the patient is supported to complete the provider’s treatment plan.
• Ensures continuity of care by providing transportation assistance, and appointment reminders.
• Assists with tracking outcomes of referrals and treatments.
• Provides support and advocacy during initial medical visits and to assure members' medical needs and referrals are being conveyed as needed.
• Addresses SDOH needs by providing referrals for services to community agencies as appropriate. Follow up with patients regarding health/social services plans, where needed.
• Serves as a liaison between the patient and external healthcare systems, assisting as needed.
• Enhances the patient experience by practicing AIDET during each patient interaction.
• Conducts transitions of care activities with the patient’s medical home care management team or the Central Health case management team as indicated to support patients with SDOH needs.
• Develops positive working relationships with external clinic systems.
• Maintains ongoing communication with community partners and attends various community events to promote education and awareness of safety net programs as assigned by Supervisor.
• Participates in daily patient care (unit) huddles.
• Participates in continuous quality improvement projects in order to better serve the patient, family and healthcare system to improve the quality of service provided.
• Attends staff meetings and education offerings both in person and via teleconference/online as required.
• Supports organizational initiatives to promote and maintain a strong positive workplace culture.
• Performs other duties as assigned.

Knowledge/Skills/Abilities:
 Strong interpersonal skills.
 High level of skill at building relationships and providing excellent customer service.
 Excellent verbal and written communication skills.
 High level of problem-solving skill to better serve patients and staff.
 Ability to work with diverse groups of people.
 Demonstrated familiarity with tools, technology, and systems typically found within most health care environments, (i.e. EHR, personal computer skills, including Microsoft Office)

MINIMUM EDUCATION: Graduation from high school or equivalent

MINIMUM EXPERIENCE:

• One (1) year experience as a Community Health Worker

PREFERRED EXPERIENCE:
• One (1) year of experience working within a clinic setting as a Community Health Worker (CHW)
• Experience with Epic – Healthy Planet, and/or Findhelp (Aunt Bertha) platform
• Bilingual (Spanish/English) preferred.

REQUIRED CERTIFICATIONS/LICENSURE:

Holds and maintains these certifications as a professional. Lapsing/expiration of these certifications/licensure will result in suspension of work: Community Health Worker (CHW) Certification by the Texas Department of State Health Services

REQUIRED COURSES/COMPLETIONS (e.g., CPR):
BLS obtained through American Red Cross or American Heart Association