<p>Position Overview: The Community Health Worker (CHW) is responsible for helping patients and their families navigate and access community services, resources, and adopt healthy behaviors. The CHW supports providers and the care team members through an integrated approach to care management and community outreach. Activities will promote, maintain, and improve the health of patients and their families by addressing social determinants of health (SDOH) that impact client health. The CHW provides social support, informal counseling, and advocates for individual and community health needs.</p> <p>Core Competencies:</p> <ul> <li>Good organizational skills to handle multiple priorities while remaining professional and calm. </li><li>Ability to work with diverse people. </li><li>Effective telephone skills. </li><li>Strong level of confidentiality due to the sensitivity of materials and information handled. </li><li>Ability to make suggestions on workflow or system efficiency and effectiveness. </li><li>Ability to work independently, be self-directed, and flexible. </li><li>Ability to prioritize and perform functions with minimal supervision. </li><li>Understanding of care plans and carrying out deliverables. </li><li>Understanding of social determinants of health Screening Tools: </li><li>PRAPARE </li><li>ACE </li></ul> <p>Key Deliverables:</p> <ul> <li>Establish trusting relationships with patients and their families while providing general support and encouragement. </li><li>Provide ongoing follow-up, basic motivational interviewing. </li><li>Follow up with patients via phone calls, home visits, and or to other settings where patients can be found. </li><li>Help patients set personal health-related goals and attend appointments. </li><li>Provide referrals for services to community agencies as appropriate. </li><li>Help patients connect with transportation resources and provide appointment reminders. </li><li>Effectively communicate NFP's mission and working closely with medical providers. </li><li>Record patient care management information in the EMR and other software within 2 business days of patient contact. </li><li>Manage assigned caseload of patients. </li><li>Comply with and understand all HIPAA and confidentiality requirements at all times. </li></ul>