Community Health Worker

Job Description

Job Description

Title :  Community Health Worker

Location :  Oregon City, OR 97045  (will travel to surrounding clinics and community spaces)

Duration :  PERM

Shift :  5x8s , Monday to Friday, 8 am-5 pm

Pay :   $25 / hour - $32.50 / hour  (dependent on experience)

Job Duties :

• Assist patients with social issues like houselessness, substance abuse and mental health resources, and food insecurity resources, and assess need through social determinants of health (SDOH) screenings.
• Assist patients with organizing their medical care by making follow-up appointments, filling prescriptions, and connection to specialty health as needed.
• Support patients through providing resources to connect to benefits and public assistance program; examples are health insurance, food stamps, and other resources as needed.
• Initiate a follow-up call to patients who have been discharged from the emergency department or hospital following behavioral health crises within 24-48 hours post discharge. Assess and offer mental health resources, SDOH screening, care coordination, and scheduling with behavioral health and clinical pharmacy post hospital or ED visits.
• Build rapport with patients to engage them in their care plan, offering encouragement and guidance in addressing their behavioral health needs.
• Collaborate with the primary care team, Behavioral Health Consultants (BHCs), and external providers to ensure smooth transitions of care and continuity of services for patients’ post-discharge.
• Assist patients in scheduling follow-up appointments with behavioral health providers, primary care physicians, or other relevant services.
• Connect patients to community resources that address social determinants of health (e.g., housing, food, transportation) that may impact their mental health or substance use recovery.
• Identify patients at risk for further crises and escalate cases to the care team or appropriate emergency services as needed.
• Maintain accurate records of patient interactions, interventions, and referrals in the electronic health record (EHR) system.
• Conduct regular follow-ups with patients to assess their progress, adherence to care plans, and any new or ongoing needs.
• Communicate all care and coordination activity, risks and care plans using standard documentation, information technology and care coordination tools in the electronic medical record.
• Be the system coordinator and point of contact for patients and families. May assume an advocate role on the patient’s behalf to ensure approval of the necessary services or accessibility of needed resource(s) for the member in a timely fashion.
• Create collaborative relationships with staff across departments within the team, and externally, to promote collaboration and multi-system coordination.
• Increase access to health and heath care services through innovative health models, virtual care strategies and collaborative community partnerships.
• Apply motivational interviewing and patient centered approaches to address concerns around barriers to healthcare needs to improve the care experience and motivate patients to meet their health goals.
• Ability to work independently with accountability and exercise sound judgment, discretion, and professionalism at all times.
• Participate in on-site events, clinics, and outreach initiatives as assigned.

Requirements :

Plusses :

Salary : $25 - $33