Certified Community Health Worker

This position is an advanced Community Health Worker responsible for working largely independently communicating with Care Transitions staff members, University Hospitals Patients, Providers and Community Health Worker Partnered Sites.

What You Will Do

• Leading Community Health Worker Initiatives that promote CHW services and addressing social barriers to care to decrease health inequity.
• Successfully supports a primary care office with essential tasks related to social determinants of health and community resource connection for patients duties as needed or requested.
• Uses Documentation and Referral systems correctly and consistently i.e. Unite Us, Medical Records, Redcap, Better Health Partnerships CCS.
• Effectively carrying out traditional Care Transitions Community Health Worker responsibilities independently and at an advanced level which include: working on piloting of system initiatives, completing patient assessment forms, identifying gaps in care, and helping individual patients resolve barriers to care.
• Collaborates with all members of the health care team, patient and family to coordinate timely and efficient reduction of social barriers that impact patient care.
• Utilizes best practices established by team leadership consistently and in appropriate circumstances
• Provides social/emotional support and enhanced care coordination to complex patients
• Maintains a rotating caseload of 30 patients of varying medical and mental complexity
• Excels in Health Literacy Translation and motivational interviewing
• Maintains working knowledge of community needs and developments
• Excels in understanding of Social Determinants of Health and impact of social barriers on access to care and health equity.
• Notable track record of direct support and advocacy of client's person centered goals and Develops, documents and implements a comprehensive plan based on identified psychosocial needs and/ or discharge needs.
• Provides linkage to community resources, and serves as liaison to community agencies.
• Communicates/collaborates with the work team using a multidisciplinary approach.
• Provides guidance/consultation to peers/team regarding complex psychosocial and /or discharge planning issues/barriers.
• Provides mentorship (including: professional development/continuing education training, active within the community they serve, excels in workflows of multiple work sites .)
• Established population niche and demonstrates expert knowledge in specific population
• Networks in the community builds relationships with community partners and increases access to patient resource needs actively participates in team building and takes initiative to coach team members Demonstrate ability to manage multiple pathways of communication with patients and providers

Additional Responsibilities

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.