Community Health Worker - Care Management - MA/CNA/LPN

Esse Health•St. Louis, MO

11h•Hybrid

About The Position

The Community Health Worker (CHW) is a member of the care management team partnering with Primary Care Physicians to enhance patient health outcomes. This role is responsible for accessing community services for patients and their families. Upon referral the Community Health Worker will assist patients in accessing community services for their specific needs. The Community Health Worker supports the care continuum by serving as a liaison between providers and assists with the enrollment of services and community resources by delivering culturally competent care. The Community Health Worker will incorporate both face-to-face and telephonic-based services. The CHW is responsible for working collaboratively with the patients, family, physicians, and the entire health care team. The CHW will ensure that patients have the necessary support, resources, education, follow-up appointments, and home care needed to improve outcomes and reduce the risk of re-hospitalization.

Requirements

Medical Assistant (MA) certification or Community Health Worker (CHW) accreditation.
1-3 minimum years of experience in case management, care coordination, and/or community outreach.
Knowledge of and experience working with Medicare and value-based care populations, including familiarity with covered benefits and available services.
Ability and willingness to travel locally within a 45-mile radius from 63141 (utilizing personal vehicle).
Proficiency in using electronic medical record (EMR) systems.
Strong computer skills, including proficiency with Microsoft Outlook, Microsoft Teams, and multiple web-based applications.
Demonstrated ability to work independently, manage a caseload, prioritize tasks, and meet established deadlines.
Excellent attention to detail with strong organizational and time management skills.
Effective written and verbal communication skills, with the ability to interact professionally with patients, caregivers, and interdisciplinary teams.

Nice To Haves

Licensure or certification as a Licensed Practical Nurse (LPN), Certified Nursing Assistant (CNA)/Home Health Aide (HHA), or Certified Medical Assistant (CMA), preferred.

Responsibilities

Completes applications for community and health-related resources; prepares documentation for provider visits; and provides additional administrative support as needed.
Tracks, monitors, and follows up on referrals and outcomes related to pharmacy services, durable medical equipment (DME), and home care.
Assists patients with identifying, arranging, and scheduling transportation; advocates on behalf of patients; supports clinical staff (including administering health screenings, as applicable); and coordinates care by identifying resources and addressing barriers to access.
Develops, maintains, and regularly updates comprehensive resource inventories for assigned service areas across multiple states.
Recognizes situations requiring mandatory reporting and completes all reporting in accordance with applicable state regulations and organizational policies.
Provides care coordination services through both telephonic and in-person interactions.