Position Summary

The Community Health Worker (CHW) is responsible for helping patients and their families to navigate and access community services, other resources, and adopt healthy behaviors. The CHW supports providers and the DPP team through an integrated approach to care management and community outreach. As a priority, activities will promote, maintain, and improve the health of patients and their family. CHW provides social support and informal counseling, and advocates for individuals and community health needs.

Primary Responsibilities include:

• This is a position dedicated to our community-based diabetes program which coordinates efforts between clinical teams, coordinators, and sub-specialists for our DPP.
• A solid understanding of diabetes and diabetes education is an essential component of this role.
• Responsible for establishing trusting relationships with participants providing general support and encouragement.
• Provide ongoing follow-up, basic motivational interviewing, and goal setting with participants.
• Follow – up with participants via phone calls, home visits and visits to other settings where participants can be found.
• Help participants set individual health related goals and set appointments.
• Provide referrals for services to community agencies as appropriate.
• Enter and maintain all necessary notes, forms and supplementary information through weekly checks and updates to promote efficiency.
• Meet with participants, individuals and community organizations as needed to create health programs designed for individual use and for groups.
• Participate in weekly outreach efforts to raise community awareness of general health, new diets/exercise programs and health risks.
• Review currently existing programs and health initiatives to ensure up-to-date, effective and safe for their intended audience(s).
• Reach out to participants daily using a variety of mediums (phone, Skype, in-person) to check up on their progress, answer questions, make personalized recommendations and changes to their programs if necessary.
• Complete administrative tasks on an ongoing basis to ensure proper and organized record keeping, working with staff members when/if necessary.

Essential Duties

• Coordinates a wide range of health education services, including establishing effective referral and facilitating use of community services to promote the delivery of cost-effective health education services.
• Health education
• Providing information on community health resources
• Determining program eligibility and assistance with enrollment in programs
• Making referrals; tracking and supporting appointments and providing reminders
• Managing medication tracking with participants
• Translating for the patient (or referral to translation services)
• Coordinating transportation
• Perform other duties as assigned

Education and Experience

• Associates degree in social work, counseling, behavioral health, psychology
• At least 2+ years of related experience, or an equivalent combination of education, training, and experience.
• Two or more years of experience working in health research, public health programs and/or community-based organizations that provide health services.
• High School diploma and at least 4 years of experience in community work, community outreach and education.
• Experience with diabetes programs preferred and community-based outreach experience.
• Always demonstrates professionalism and tact; active and empathetic listening
• Understands and adheres to client confidentiality
• Provides a multi-disciplinarian healthcare knowledge base and approach
• Works well as part of the team
• Displays flexibility, enthusiasm, positivity and shows initiative
• Able to handle multiple tasks at once, meet deadlines, detailed, flexible, able to manage relationships.
• Excellent organizational and interpersonal skills.
• Ability to work independently.

Clinify Health is an Equal Opportunity Employer.