FUSE Community Health Worker

St. Peter's Health Regional Medical Center•Helena, MT

18h

About The Position

This position is project dedicated based on the success of the Housing is Healthcare FUSE program. The Community Health Worker partners with other care team members to empower patients to meet their health goals. Community Health Workers understand the communities they serve, which allows them to act as intermediaries between patients and healthcare and social services providers. The Community Health Worker will be responsible for assisting patients with a variety of care coordination activities which will vary based on patient needs. Community Health Workers work directly with patients and their families to address social determinants of health including transportation, housing, food security, and caregiver support by connecting individuals to community resources and help to eliminate barriers to care. Tasks include: • Meeting with patients and their families in their homes. • Assist patients and their families with a multitude of complex services including navigating the health care system and community resources. • Conducts a social determinants of health screening. o Assess patient’s support system, education, employment, current living arrangement, and financial situation/insurance coverage o Assess patient’s current coping strategies. o Review for barriers that may be preventing them from receiving the care they require. o Assist with connecting patient to community resources based on patient’s identified needs • Collaborate with primary care team to facilitate optimal health outcomes. o Assist with basic health services at the discretion of primary care team instructions. • Attend Case Conferencing and collaborate with outside community service providers. • Facilitate advance care planning conversations. • Assist patients with maintaining or obtaining insurance, as well as applying for Patient Assistance and assistance from St. Peter’s Health Foundation. o Assist patients with the screening process by MASH advocate for Medicaid eligibility. o Ensure all edible patients are enrolled in Medicaid. o Assist with completing a Medicaid application. o Coordinate in home support services through Medicaid. o Assist with making Medicaid waiver referrals for ongoing community support. • Assist with housing applications. • Keep current with changes in community resource availability and/or funding. • Maintains ongoing professional relationships with community agencies. • Encouragement of enjoyment of activities that patients have always enjoyed and assistance with setting goals for the future o Assist patients with self-management support to improve health and overall well-being. o Help patients develop an action plan to achieve goals. • Conduct community health outreach programs.

Requirements

Knowledge of Helena community resources and experience in navigating community resources.
High school diploma or equivalent preferred.
Proof of previous completion of a Community Health Worker training course, or completion of the Community Health Worker training course within six months of hire.
BLS Required.
MT Driver’s License, car insurance, and vehicle (mileage reimbursed).
High degree of interpersonal communication and negotiation skills.
Strong organizational and time management skills.
Ability to work independently.
Ability to work with individuals who have a high ACE (Adverse Childhood Experiences) score
Ability to “meet patients where they are” and treat individuals with compassion and empathy
Ability to provide motivational interviewing and trauma informed care
Ability to advocate for patients of the Helena community

Nice To Haves

Lived experience (ie. Previous homelessness / housing crisis, social determents of health, social support (SNAP, TANF, etc.) is preferred but not required.
Previous experience as a CNA, CMA, or role in a social support office preferred but not required.

Responsibilities

Meeting with patients and their families in their homes.
Assist patients and their families with a multitude of complex services including navigating the health care system and community resources.
Conducts a social determinants of health screening.
Assess patient’s support system, education, employment, current living arrangement, and financial situation/insurance coverage
Assess patient’s current coping strategies.
Review for barriers that may be preventing them from receiving the care they require.
Assist with connecting patient to community resources based on patient’s identified needs
Collaborate with primary care team to facilitate optimal health outcomes.
Assist with basic health services at the discretion of primary care team instructions.
Attend Case Conferencing and collaborate with outside community service providers.
Facilitate advance care planning conversations.
Assist patients with maintaining or obtaining insurance, as well as applying for Patient Assistance and assistance from St. Peter’s Health Foundation.
Assist patients with the screening process by MASH advocate for Medicaid eligibility.
Ensure all edible patients are enrolled in Medicaid.
Assist with completing a Medicaid application.
Coordinate in home support services through Medicaid.
Assist with making Medicaid waiver referrals for ongoing community support.
Assist with housing applications.
Keep current with changes in community resource availability and/or funding.
Maintains ongoing professional relationships with community agencies.
Encouragement of enjoyment of activities that patients have always enjoyed and assistance with setting goals for the future
Assist patients with self-management support to improve health and overall well-being.
Help patients develop an action plan to achieve goals.
Conduct community health outreach programs.
Functions as a member of a self-directed work team ensuring appropriate coverage as indicated by the needs of the department and population served.
Participates in performance improvement activities.
Participate in orientation of new employees.
Collects data essential to promote Population Health.
Works in collaboration with all personnel within the department and throughout St Peter’s Health and community organizations.
Completes and/or attends all required educational offerings.
Demonstrates the ability to manage time, coordinate departmental functions and promote departmental and professional growth.
Ability to use electronic health record and other electronic applications.
Operates copying machine, fax machine, and computer.
Handling AV equipment, materials, supplies, and patient belongings.
Performs other duties and responsibilities as assigned and within time frame specified.