Community Health Worker

St Johns Community Health•Gardena, CA

18d

About The Position

Under the direction of the ECM Program Manager and the Community Health Worker (CHW), this role involves outreach and enrollment of clients into Enhanced Care Management. The CHW services also assist individuals preparing for release from jail by providing basic housing assistance, patient-tailored intensive case management, developing care/service plans, and linking them to necessary medical, psychiatric, social, educational, and other services. The CHW will collaborate with Community Supports Program staff to deliver team-based, patient-centered care management for homeless and at-risk-of-homelessness patients. Shared lived experience with potential clients is strongly desired for this role.

Requirements

High School Diploma or GED
Familiar with working with managed care plans and / or Medi-Cal
Experience working with an Electronic Health Record system; eCW preferred.
Must be able to work independently and alongside a team in assisting clients meeting their goals.
Available to work Monday-Friday, and some Saturday’s when needed, as well as evenings to program and clinical needs.

Nice To Haves

Bilingual English & Spanish (Preferred)
Shared lived experience with potential clients is strongly desired

Responsibilities

Conduct assessments and coordinate all aspects of care, transportation, referrals, and scheduling for patients.
Promote and aid patients in establishing self-management skills, linking them to resources in the community including public benefits and social services.
Crisis management and patient advocacy.
Maintain patient file/record of appointments, services, follow-ups, and assessments based on DHCS requirements of ECM Program and SJCH requirements.
Liaison between client and community resources, medical/specialty offices, and/or when support is needed.
Work with Medical providers, specialists, therapists, social workers, etc., internally and externally, to determine health priorities.
Empower, support, and educate clients in their re-integration process through mentorship.
Operate in a supportive role within an interdisciplinary health care team utilizing an integrated care and treatment model.
Maintain outreach activity calendars and logs according to program standards.
Collaborate with primary care providers and behavioral health providers to provide health and behavioral interventions that will maximize patient health outcomes.
Provides support, empowerment, education, and targeted case management services to clients.
Conducts assessments of client's history with medical/dental/behavioral health services, social and economic resources for purposes of linkage.
Educates clients with chronic illness about evidence-based standards of care and self-management of their chronic illness.
Links clients to needed services and facilitates access to community resources.
Advises clients and others regarding healthcare and other facilities available to them; assists patients in utilizing services; makes follow-up contacts when required.
Attending regularly scheduled and impromptu meetings and maintain communication with program team members and supervisor.
Attend appropriate community resource meetings and training, as assigned.
Work in collaboration with other departments and agencies when required.
Other duties may be assigned or may be modified as business needs dictate.