Bilingual Community Health Worker

Suvida Healthcare•Katy, TX

123d

About The Position

The Guia is responsible for an assigned panel of patients and works with a multidisciplinary primary care team to help patients meet preventive, chronic, acute, and social care needs. The Guia encourages patients to take an active role in their health by offering tools and education that support healthy lifestyle choices and lasting health behaviors. The role focuses on building trusting, supportive relationships with patients and families and helping them address social needs. Guias work with patients in clinical and community settings alongside medical providers, nurses, medical assistants, and other team members to improve patient outcomes.

Requirements

4–5 years of experience working in a healthcare setting or relevant experience.
Expertise connecting patients with community resources and governmental agencies and ensuring closed-loop referrals for complex social needs.
Experience managing the needs of senior or geriatric populations.
Ability to work independently and build collaborative relationships with physicians, families, patients, interdisciplinary team members, and community agencies.
Strong organizational and time-management skills, including the ability to prioritize multiple tasks and role components.
Knowledge and expertise in completing benefit applications such as SNAP, LIS, PAP, and prescription assistance.
Effective oral and written communication skills.
Proficiency with EMRs, computers, mobile devices, medical devices, and Microsoft Office Suite.
Experience using electronic medical records and social service referral management software.
Experience assessing and addressing social determinants of health.
Excellent therapeutic communication with patients, families, and caregivers.
Ability to articulate Suvida Healthcare’s mission in relation to patient satisfaction and outcomes.
Compassionate, kind, and open-minded approach.
Teamwork experience.
Ability to communicate and interact effectively with people across cultures and ranges of ability, genders, ethnicities, and races.
Ability to care for patients in home, clinic, and remote settings.
Bilingual and bicultural in English and Spanish.
Community Health Worker certification.

Nice To Haves

Bachelor’s degree (preferred).

Responsibilities

Provide comprehensive care coordination for an assigned patient caseload.
Work with patients, families, caregivers, healthcare providers, and external partners to address complex social needs.
Promote communication and collaboration among patients, families, caregivers, internal multidisciplinary teams, and other healthcare team members so integrated care is appropriate and beneficial.
Intervene with patients and families regarding the emotional, social, and financial consequences of illness or disability.
Conduct in-person home visits as needed, following the Home Safety Measures Policy.
Access and mobilize family and community resources to meet social care needs.
Document interventions in the patient medical record accurately and promptly, including clinic visits, home visits, phone engagement, and text messaging.
Onboard patients to the Suvida model and their medical and social care visits.
Educate patients on acute and chronic disease management and provide guidance to patients and families.
Establish healing relationships and use confidence-promoting communication techniques to strengthen patients’ self-efficacy in managing their health.
Communicate with patients in person, by phone, video conference, and text message.
Collaborate with multidisciplinary care team members, including the Guia manager, Transitions of Care managers, and Medicaid case managers.
Maintain knowledge of Medicare, Medicaid, and other program benefits to help patients make resource-allocation and benefit choices.
Consult and collaborate with other Guias and team members on patients with significant or intensive community resource needs.
Coordinate care across the continuum, including scheduling provider appointments, coordinating referrals, and sharing or transferring information with internal and external care teams.
Participate in daily primary care practice operations, including answering incoming calls and messages and helping maintain the clinical space.
Track patient enrollment and progress through care programs.
Perform other duties as assigned by the Guia Manager.