Community Health Worker

Lamoille Health Partners•Morrisville, VT

11d

About The Position

Lamoille Health Partners is seeking a Community Health Worker to join its integrated care team and help improve health equity in the community. The role works directly with patients and their families to identify health goals, address barriers to care, and create practical plans for long-term well-being. As a link between patients, healthcare providers, and local resources, the Community Health Worker provides care coordination, transitional support, and community outreach. The position uses a holistic, patient-centered approach to assess patients’ social, emotional, and financial needs; supports patients in developing self-management plans; and helps connect them with health, behavioral health, recovery, and community resources. The role also contributes to multidisciplinary care, quality improvement, accurate EMR documentation, and organizational initiatives.

Requirements

Bachelor’s degree in Human Development, Psychology, Public Health, Social Work, or a related field.
At least 2 years of experience working with chronic care needs.
Strong understanding of patient-centered engagement and motivational interviewing techniques.
Exceptional interpersonal, communication, and organizational skills.
Proficiency with electronic health records and office technology.
Ability to manage shifting priorities and work effectively under pressure while maintaining a compassionate approach.
Commitment to patient confidentiality and HIPAA compliance.

Nice To Haves

Experience working with chronic care needs in a primary care setting is preferred.

Responsibilities

Meet with patients on-site or in the community to assess social, emotional, and financial needs using a holistic, patient-centered approach.
Use motivational interviewing to build therapeutic relationships, develop self-management plans, and support patients in achieving personal health goals.
Provide brief mental health and substance use support and connect patients with internal and external behavioral health, MOUD, and peer recovery resources.
Assist patients after hospital discharge to support smooth transitions and improved health outcomes.
Help patients access low-cost medications, Sliding Fee assistance, health insurance enrollment through Vermont Health Connect, and transportation.
Build partnerships with local schools, human service agencies, and community organizations to expand access points for care.
Participate in multidisciplinary care teams and case reviews to provide wrap-around support.
Maintain accurate and timely documentation in the Electronic Medical Record (EMR).
Advocate for and educate staff about the needs of underserved populations.
Participate in Patient-Centered Medical Home (PCMH) accreditation activities, quality improvement projects using PDSA models, and departmental initiatives.