Job Description

Job Description

Job Description

Wood River Health is is now seeking a Community Health Worker ! If you are looking for a great work environment with work/life balance and fantastic benefits, this is the place!

Not only do we offer a great work environment, our benefits are fantastic! Packages include a generous paid time off program, health insurance, flexible spending account, life insurance, retirement 403(b), work/life balance , tuition assistance, and much more!

Position Summary:

The Community Health Worker (CHW) is a member of an interdisciplinary team comprised of Community Health Workers, Behavioral Health Clinicians, Nurse Care Managers and Medical providers. The CHW works closely with the core team members to support patients who are dealing with complex medical, behavioral health and/or substance issues as well as social determinants of health and require a more intensive home and community-based intervention. CHW visits patients in their homes and in the communities in which they live, providing culturally sensitive approaches to health information to improve health literacy. The Community Health Worker facilitates the patient’s decision-making and self-management to help patients engage in their overall health and achieve their health goals. This individual will be responsible for tracking patient-related activities, monitoring and documenting progress. This position works collaboratively with the primary care team to promote patient-centered care and actively participates in multidisciplinary patient-centered team huddles. The CHW has frequent contact with many community agencies on behalf of the patients served, networking and collaborating on resource identification to improve the overall health of the population. Essential Duties include:

• Helping individuals, families, groups, and communities develop their capacity and access to resources, including health insurance, food, housing, quality care and health information
• Support individuals with housing needs, providing assistance with applications, case management of those in housing stabilization programs, and coordinate transitions into sustainable housing
• Facilitating communication and client empowerment in interactions with health care/social service systems
• Initiates outreach and successfully engages with patients, scheduling appointments and providing follow-up contact within designated timeframes
• Completes initial intake, including a comprehensive assessment of social needs, functional assessment of the patient in the home setting, and condition of the home if needed within designated timeframes
• Builds trusting relationship and serves as an advocate and mentor with the goal of empowering the patient to become more independent and self-sufficient
• Collaborates with nurse care managers, physicians, other care team members (Medical Assistants, Nurses, dental, behavioral health, etc.), hospitals, partner agencies, to improve patient care
• Work collaboratively in line with Health Equity Zone goals to positively impact populations in Washington County who are identified as at-risk
• Following WRH policies, obtain releases, gathers PHI from outside providers involved in patient care as needed and processes documents according to program requirements
• Within scope of CHW training, accompanies patients to doctor’s appointments, assists with food planning/shopping, completing forms for benefit applications, and assists with other tasks as needed that support their medical, behavioral health and social needs
• Educates patients on appropriate Urgent Visit and ED use
• Utilizes a multi-disciplinary team approach to address opportunities to plan and coordinate care
• Utilizes Motivational Interviewing skills and other patient engagement techniques with patients and caregivers
• Assists in the development of a patient care plan to include actions designed to improve the patient’s health status and remove the barriers that are preventing them from gaining access to high quality and timely primary/specialist care
• Leverages EMR/chronic disease registry reporting to prioritize patient follow-up
• Identifies and utilize culturally sensitive approaches and community resources
• Documents activities and communications in the patient chart
• Provides training to other team or practice staff as needed
• Acts as liaison to health plans, hospital, long-term care, BH specialists and home health representatives
• Works with HEZ partner organizations to improve transition of care and prevent avoidable ED visits for behavioral health
• Attends required training and collaborative sessions as scheduled
• Delivering health information using culturally appropriate terms and concepts
• Linking people to health care/social service resources
• Providing informal counseling, support, and follow-up
• Advocating for local health needs through meetings with patients over the phone or in person through community and home visits
• Providing health services, such as monitoring blood pressure and providing first aid within the scope of training
• Outreach patients in a timely manner, conduct home or community visits, and administer assessments to identify patient needs
• Maintain timely, accurate records, documentation, and reports as required
• Off-site travel will be required
• Maintain strict confidentiality in all matters
• Operate within the scope of the Health Information Portability and Accountability Act to safeguard the privacy of protected patient health information
• Enliven and support the mission, vision, and values of Wood River Health
• Adhere to organizational policies and procedures and Wood River Health Compliance Program Standards
• Performing other duties as assigned to meet business needs

The ideal candidate will have:

• High School Diploma or equivalent.
• Associates or Bachelors degree in Social Work, Community/Public Health or related health sciences field a plus
• A combination of training and skills to effectively carry out responsibilities and assignments (such as previous experience working with patients in a community-based setting).
• Training and/or experience related to Affordable Housing, including understanding of eligibility
• The ability to travel to various locations is required. Must possess a valid, current State issued driver’s license, have reliable transportation and proof of current auto insurance at State minimum levels required.

Grant funded position

Wood River Health is an Equal Opportunity Employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, sexual orientation and gender identity), national origin, age, disability, genetic information, protected veteran status, or any other characteristic protected by federal law.

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