Community Health Worker - Pediatrics and Obstetrics

Central Health•Austin, TX

17d

About The Position

In partnership with patients, their families as defined by the patient, and multidisciplinary teams, the Community Health Worker (CHW) delivers patient-centered care coordination for individuals requiring specialized services. The CHW collaborates with patients, parents or guardians, caregivers, healthcare providers, educational systems, and interdisciplinary teams to ensure comprehensive, integrated, and compassionate care. The role includes direct patient engagement in telehealth and in-person settings, outreach to identify social and community needs, advocacy, goal-setting support, follow-up, care transitions, and referrals to community-based services. The CHW documents patient care, participates in team meetings and quality-improvement activities, maintains professional development and certification requirements, and builds collaborative relationships with patients, families, colleagues, and community partners. All work must follow program protocols, professional standards, regulatory and accreditation requirements, and organizational policies and procedures.

Requirements

High school diploma or equivalent; a higher degree is accepted.
At least 3 years of experience working in a community health setting in a healthcare role or a community-based human service agency as a Community Health Worker, health educator, community outreach worker, or community organizer.
Texas Certified Community Health Worker (CHW) certification upon hire.
Case Management for Children and Pregnant Women (CPW) certification through Texas Health and Human Services within 30 days.
Valid Texas driver’s license upon hire.
Strong problem-solving abilities in dynamic care environments.
Exceptional attention to detail and accuracy in documentation, patient care, and task execution.
Excellent verbal and written communication skills.
Ability to deliver high-quality CHW services consistent with professional standards and ethical guidelines.
Ability to manage multiple CHW responsibilities while maintaining efficiency and quality.
Experience in direct client engagement, including advocacy and coordination of community resources.
Competence with healthcare technologies and systems, including electronic medical records, patient documentation platforms, and standard office software such as spreadsheets and word processing.

Responsibilities

Interact with patients through telehealth and in-person appointments in clinics, community spaces, schools, and other locations according to program guidelines.
Serve as a point of contact for patients enrolling in services.
Collaborate with patients, parents or guardians, caregivers, medical providers, school systems, and interdisciplinary healthcare teams on patient-centered care.
Advocate for patients and families to ensure services meet their needs and resources are used appropriately.
Empower patients and families to participate actively in care management.
Conduct outreach and engagement to identify social and community needs affecting health and well-being.
Help patients and families set achievable goals, and support their progress through follow-up and encouragement.
Monitor patients’ biopsychosocial needs and provide timely follow-up in accordance with program protocols.
Coordinate transitions between care sites and providers.
Coordinate and streamline referrals to appropriate community-based services.
Deliver direct CHW care in accordance with program protocols and established standards of practice.
Complete accurate, timely documentation of direct and indirect patient care and keep medical records current and compliant with organizational standards.
Participate in daily unit-based patient care huddles, clinic-wide informational meetings, patient conferences, and planning sessions.
Participate in professional development seminars and educational sessions, comply with certification requirements, and stay current with field practices.
Participate in implementing and evaluating quality-improvement strategies, follow evidence-based guidelines and standards, and identify opportunities to improve outcomes and care delivery.
Ensure patient care tasks, administrative processes, and related duties comply with regulatory and accreditation standards, including The Joint Commission and CommUnityCare policies and procedures.
Cultivate positive working relationships and strategic partnerships with colleagues across departments.
Communicate effectively with care team members to provide coordinated, patient-centered care.
Engage respectfully and collaboratively with patients and families using a trauma-informed approach.
Participate in community events and maintain partnerships to promote awareness of health and social services, as assigned by a supervisor.
Perform other duties as needed to support the organization’s vision, mission, and values.