HCS Community Health Worker (REMOTE IN TEXAS ONLY)

Overview:

The Community Health Worker (CHW) will be responsible for helping members and their families to navigate and access community services, identify, and overcome barriers to care, provide health education, and adopt healthy behaviors. The CHW will provide social support and informal counseling and advocate for member health needs to improve care and health outcomes.

The CHW will perform outreach for High-Risk members, Quality initiatives, and other special projects as assigned. The CHW will assist in new CHW team training assists new team members with questions related to policies and process.

Under the direct supervision of the Community Health Worker Manager, CHW's will work closely with the Case Management team consisting of Nurse Case Managers, Behavioral Case Managers, and Social Workers. The CHW is an integral part of reenrolling Central Health's Premium Assistance Program (CHAP) Expansion (EXP) members in the CHAP EXP program. The Community Health Worker will primarily perform telephonic outreach to high-risk members enrolled in the CHAP EXP program, including evaluation of member's needs, medications, assisting with obtaining appointments, and follow up on member's needs. The CHW will perform home visits on identified high-risk members and attend provider appointments as needed.

Essential Functions:

• Completing a whole person assessment with questions in regard to member’s current and past medical history including behavioral health and social determinants of health.
• Medication adherence and review to confirm they are on the Sendero formulary if they aren’t CHW assist in obtaining prescription to a formulary drug or an override as needed. Assist members in obtaining prior authorization for specialty medication and apply for financial assistance as needed.
• Assist members in finding in network providers and obtaining the required referrals from the members PCP for specialist, durable medical equipment, and outpatient services such as PT, OT, SP and home health and other covered services.
• Learn and follow policies and procedure for referring members to the Nurse Case Management program, Social Work program, and Behavioral Health program.
• Act as an advocate and liaison between the member/family, provider, health plan, and community service agencies.
• Assist CHAP expansion members with the yearly reenrollment to the CHAP program by completing telephonic outreach, reassess member for member needs, and assisting with the gathering of necessary verification documents, application completion in REDCap. Monitoring application status and notifying member of outcome.
• CHWs will maintain an active caseload on all assigned members as long as they remain effective with Sendero. Outreach on all assigned members will be completed on a quarterly basis at minimum based on member acuity. All minimum outreach includes review of physical and mental health needs, medications, upcoming appointments, and transportation needs. 
• Follow-up with members via phone calls, text message, email, home visits, and visits to other settings where patients can be found such as clinics and facilities.
• Will assist with trainings for new CHW team members by allowing new CHWs to shadow their workday, providing tips on member interactions, and demonstrate documentation process.
• Assists with maintaining CHW documents organized.
• Learn process and perform outreach for quality initiatives such as Pregnancy and Postpartum, Diabetic Eye exam, Colorectal Cancer, High Blood Pressure, and others as assigned.
• Effectively work with people from diverse backgrounds to identify and reduce cultural and socio-economic barriers.
• Must have written and oral fluency in Spanish and English.
• Provide culturally appropriate health education on topics related to chronic disease prevention, maternal and child health, physical activity.
• Help member develop health management plans and goals.
• Coach members in effective management of their chronic health conditions and self-care.
• Provide ongoing follow-up, basic motivational interviewing, and goal setting with members/families.
• Must be able to verbally communicate proficiently and present yourself professionally.
• Follow-up with members via phone calls, home visits and visits to other settings where patients can be found.
• Help members find community resources, including scheduling appointments to obtain resources, and assisting with completion of applications for programs for which they may be eligible.
• Assist members in accessing health related services, including obtaining a primary care provider, overcoming barriers to obtaining needed medical care and social services.
• Help patients connect with transportation resources and give appointment reminders in special circumstances; transporting patients is strictly prohibited.
• Attend regular staff meetings, trainings and other meetings as requested.
• Attend weekly in patient rounds, weekly behavioral in-patient rounds, and provide input for assigned members.
• Attend member specific multidisciplinary meetings to discuss all complex members and provide feedback.
• Attend meetings specific to assigned special projects at management discretion.
• Work collaboratively and effectively within a multidisciplinary team.
• Document activities, plans of care, and results in an effective manner while strictly adhering to the policies and procedures in place.
• Other duties as assigned.

Knowledge, Skills and Abilities:

• Knowledge of some medical terminology.
• Computer skills and experience with Microsoft Office Products.
• Critical thinking/problem solving
• Ability and willingness to provide emotional support, encouragement and motivation to members
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, and providers.
• Flexibility, willingness to learn new responsibilities
• Willingness to work in a constantly changing environment.

Minimum Education:

• High School Diploma or equivalent

Required Experience:

• 1 year of experience working in a community-based setting Required

Preffered Experience:

• 2 years of experience as a Community Health Worker at an insurance company Preferred
• 5 years of experience working in a community-based setting Preferred
• Written and oral fluency in Spanish and English Preferred

Preferred License:

• Certification by the TX Department of State Health Services as a Promotora/CHW Preferred