Community Health Worker

COAL COUNTY GENERAL HOSPITAL•Coalgate, OK

About The Position

The Community Health Worker (CHW) will play a key role in supporting individuals enrolled in a health-related program focused on improving food access and health outcomes for individuals with chronic conditions like type 2 diabetes, heart disease, and hypertension. The CHW will guide participants through the enrollment process, provide ongoing support, track participation in the program, and ensure they receive necessary resources like food deliveries and educational materials. Conduct Health Related Social Needs (HRSN) screenings with patients e.g., Fresh RX, transportation (SODA), Sooner Care, and other options for community support as identified. Refer and enroll patients in applicable support programs explaining benefits and requirements for participation. Assist participants in identifying their health challenges, including managing chronic diseases, and provide motivational support. Ensure participants have basic needs (e.g., working refrigerator, cooking ability) and willingness to engage with the program. Administer baseline and follow-up surveys to participants, recording their health status and progress throughout the program. Manage and store survey data, ensuring forms (including consent forms) are securely saved. Track participants’ completion of online or in-person health classes, ensuring they stay engaged with the program. Oversee food deliveries to participants, ensuring that they receive proper nutrition and providing guidance on food preparation, including recipes. Facilitate home visits, when necessary, to ensure participants have received food and conduct health-related assessments. Collaborate with health system leaders to ensure HRSN workflows are effective and sustainable. Assist in identifying individual and/or community needs which encourage healthy lifestyles and environments (i.e., community resources, transportation assistance, exercise programs, etc.) Collaborate with community partners (including, but not limited to; FQHC, non-profits, community centers, churches, Health Departments, food banks, etc.) for site visits to identify eligible clients and generate new referrals for the Food is Medicine program. Serve as a point of contact for participants to address questions or concerns about their health or the program. Educate participants on healthy eating habits and lifestyle changes, providing guidance on fruits, vegetables, and other dietary needs. Coordinate health education sessions and opportunities for in-person interaction, including food pickups and health testing. Work closely with a lead CHW or supervisor to monitor participant progress and address any issues or dropouts. Maintain consistent communication with program partners, such as food vendors, testing coordinators, and other community organizations involved in the program. Work closely with the team at Fresh RX and the Hospital Association for program consultation and support as applicable. Track and report participant progress, including attendance at health classes, receipt of food deliveries, and completion of health tests. Assist in overseeing and managing participant data to ensure the program meets its goals.

Requirements

Passion for health and wellness, with a basic understanding of chronic disease management (e.g., diabetes, heart disease)
Experience working with underserved and vulnerable populations
Ability to communicate effectively and motivate participants
Strong organizational skills for managing data, coordinating food deliveries, and scheduling educational sessions
Comfortable with home visits and direct participant engagement
Familiarities with health tracking and data management is a plus
Ability to work in a team environment and collaborate with other CHWs and supervisors
Basic computer skills including knowledge of Microsoft Office programs

Nice To Haves

Training in community health or related field (CHW certification is a plus)
Experience in public health, social work, or a related field
Knowledge of nutrition and health food preparation
Ability to manage participant data using digital tools for databases

Responsibilities

Guide participants through the enrollment process
Provide ongoing support
Track participation in the program
Ensure participants receive necessary resources like food deliveries and educational materials
Conduct Health Related Social Needs (HRSN) screenings with patients
Refer and enroll patients in applicable support programs explaining benefits and requirements for participation
Assist participants in identifying their health challenges, including managing chronic diseases, and provide motivational support
Ensure participants have basic needs (e.g., working refrigerator, cooking ability) and willingness to engage with the program
Administer baseline and follow-up surveys to participants, recording their health status and progress throughout the program
Manage and store survey data, ensuring forms (including consent forms) are securely saved
Track participants’ completion of online or in-person health classes, ensuring they stay engaged with the program
Oversee food deliveries to participants, ensuring that they receive proper nutrition and providing guidance on food preparation, including recipes
Facilitate home visits, when necessary, to ensure participants have received food and conduct health-related assessments
Collaborate with health system leaders to ensure HRSN workflows are effective and sustainable
Assist in identifying individual and/or community needs which encourage healthy lifestyles and environments
Collaborate with community partners for site visits to identify eligible clients and generate new referrals for the Food is Medicine program
Serve as a point of contact for participants to address questions or concerns about their health or the program
Educate participants on healthy eating habits and lifestyle changes, providing guidance on fruits, vegetables, and other dietary needs
Coordinate health education sessions and opportunities for in-person interaction, including food pickups and health testing
Work closely with a lead CHW or supervisor to monitor participant progress and address any issues or dropouts
Maintain consistent communication with program partners
Work closely with the team at Fresh RX and the Hospital Association for program consultation and support as applicable
Track and report participant progress
Assist in overseeing and managing participant data to ensure the program meets its goals