Community Health Worker Senior - Grant Programs

**Description** Summary: Conducts advanced outreach to the community. May coordinate charitable programs. Develops relationships with the community and community leaders. **Responsibilities** * The Community Health Worker (CHW) provides culturally appropriate support and information for the patient and their families in a series of structured visits and follow-up phone calls in a variety of settings, including the patient’s home * Knowledge of resources in the community and refers patients to them * Assists patients in their understanding of how to use healthcare and social services and manage their Patient Health Record (PHR) * Has a holistic and interdisciplinary approach to care management and health promotion * Builds relationships with the patient, their families, healthcare providers, and the community * Assist patients in finding and understanding how to use a Medical Home (patient’s primary choice of physician or clinic), pharmacy assistance programs, dental services, diagnostic services, transportation, behavioral health services, and other services as needed * Refer patients to healthcare and social services and follow up on all referrals * Follow care pathways (evidence-based steps) designed and selected to deal with patients’ specific health and social concerns and problems * Document activities through appropriate record keeping that follows the organization’s policies and procedures * Maintains patient registry * Consult with the administrative supervisor and clinical supervisor to coordinate activities and schedule, and to address identified health care needs of the patient * Educate patients and their families in healthy lifestyles and promote health behavior change * Encourage patient to set goals, identify barriers and challenges, and monitor their own conditions **Requirements** * Bachelor's Degree preferred **Work Schedule** 5 Days - 8 Hours **Work Type** Full Time