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Community Health Worker

Job number:

22-85

Category:

Clinic

Department:

Clinic

Status:

Full-Time Day Shift

Schedule:

Days

Description:

JOB SUMMARY

The community health worker will work collaboratively and under the direction of the care coordinator. In collaboration with the care coordinator, the community health worker is responsible for healthy lifestyle education, training, and motivational support to patients, and community resource management to encourage quality outcomes, smooth transitions, and coordination of care across the health continuum. The community health worker encourages healthy lifestyle choices to prevent and reduce long term effects of chronic illness. This position is accountable to the care coordinator for working with and representing the primary care clinic across multiple constituents.

DUTIES AND ESSENTIAL JOB FUNCTIONS

  1. Provides outreach to community resources, disease management encouragement, education and other needed clinically based activities to patients managing various chronic health conditions and to referral sources and community.
  2. Assists the RN Care Coordinator to assess and identify participant’s readiness, willingness and ability to change, identify their coaching, support, and educational needs, determine and provide relevant community and/or health care resources to support solutions; provide educational tools to promote self-management.
  3. Carries out prescribed interventions to reach established goals for behavioral modification.
  4. Participates in health and wellness coaching sessions to assist participants in making lasting changes to their health and wellness.
  5. Monitors and documents the patient’s progress toward his or her optimal level of wellness.
  6. Promotes wellness and provides education regarding preventative care measures.
  7. Acts as a liaison between referral sources, facilities and outside entities to prevent and/or resolve continuum of care issues.
  8. Communicates, as directed, with service delivery partners, providers, and other health professionals to provide care coordination so as to ensure the plan of care facilitates the efficient use of health care resources.
  9. Demonstrates skills in effectively coordinating and monitoring care to promote quality and cost effective outcomes.
  10. Assists in gathering of medical records from outside facilities.
  11. Conducts home visits and gathers information related to home safety, and other social determinants of health.
  12. Assists in the input and analysis of data generated from EHR/Registry system and identifies patients who have gaps in care and utilizes risk stratification intervention metrics for tracking and care coordination purposes.

Core Competencies

The Community Health Worker competencies include:

  • Cultural Competency
  • Community Roles and Resources
  • Health Assessment
  • Personal Safety
  • Professional Boundaries
  • Clinical components that include sub-acute and chronic patient needs.

Additionally, the Community Health Worker will work collaboratively with the care coordinator and have a basic understanding of the essential function representative of Seven Domains of Care Coordination in the primary care setting:

  • Population Health Management
  • Comprehensive Assessment and Care Planning
  • Interpersonal Communication
  • Education/Coaching
  • Health Insurance and Benefit knowledge
  • Community Resource knowledge and Research and Evaluation skills.

POSITION QUALIFICATIONS

  • Medical Assistant Certification issued by the State of Washington preferred.
  • High School Diploma or equivalent.
  • Basic First Aid and CPR certification.
  • Completion of education program specific to the 7 domains of care coordinator in primary care as indicated above or the ability to obtain within six months of hire.
  • Completion of education or history of work experience related to Health Assessments, Personal Safety and Professional boundaries.
  • Must have current WA State Driver’s License, have dependable transportation and proof of insurance. Basic computer skills required.
  • Proficient in Microsoft Word and Excel, previous experience with EMR preferred.
  • Previous work experience and clinical knowledge related to clinical aspects of sub-acute and chronic patient needs preferred.
  • Must be able to speak, read, write and understand English.

Closing:

Open until filled

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