Community Health Worker

Role Description

The purpose of a Community Health Worker (CHW) at Oak Street Health is to act as the bridge between our patients, community, and medical systems in order to remove barriers and increase wellness across all life domains. A CHW is a patient's advocate or liaison, accompanying patients through proactive in-person and phone outreach based on their care needs to promote health literacy and increase access to resources needed to live healthier lives. High levels of flexibility, problem solving, strong communication, and an intimate knowledge of the community served are required to be successful. CHWs work closely with MSWs to manage patient care plans, support care team decision making, and coordinate clinical and complementary services needed to provide high quality health care and improve the quality and cultural competence of service delivery. CHWs are expected to work within their scope of practice. There is no expected clinical license for this position.

Check out this for a sneak peek into the life of an Oak Street CHW!

Core Responsibilities Include:

• Establish and maintain strong interpersonal relationships with patients, community organizations, team members, and partners to coordinate patient needs

• Manage patient referrals defined by the care team & collaborate with the Medical Social Worker on action plan

• Facilitate communication between all identified parties involved in patients' care as needed (e.g., family members, caregivers, medical providers, community-based organizations)

• Form relationships with and build an inventory of local community organizations that may benefit our patients

• Connect patients to state and local community resources related to housing, transportation, food, and activities of daily living among other social and physical barriers to health.

• Assist patients with completion of applications for accessing eligible benefits and resources

• Promote goal setting and achievement to improve patients' quality of life and self efficacy with patients. Goal definitions are agreed upon by the care team

• Meet with patients in patient-centered and patient-preferred locations (e.g., Oak Street Health center, patient's home, external medical provider facility, community setting)

• Community Health Workers should plan to spend about half of their time outside of the center in patient-centered locations; this means having access to a reliable means of transportation to do so is required

• Drive engagement with high risk individuals (e.g., completed specialty appointments, adherence to Post Discharge Visits) may include accompaniment to appointments

• Complete referrals to organizations and agencies as needed

• Deliver culturally appropriate health education in the areas where OSH has provided competency training to the CHW

• Support care team decision making through participation in interdisciplinary team meetings

• Document interactions with patients in electronic medical record in a timely manner while maintaining HIPAA standards and confidentiality of protected health information

• Manage time, set priorities, work independently, and collaborate effectively with an interdisciplinary medical team

• Other duties as assigned

What we're looking for

We're looking for motivated individuals with:

Required

• Minimum of 1 year of experience in healthcare, community-based, case management, or social service environment

• Strong oral and written communication skills

• Ability to manage multiple priorities while maintaining a positive attitude

• Dedication to serving the community and building meaningful relationships

• Proficient computer skills (i.e. Windows, GSuite, Microsoft, etc.)

• Access to reliable transportation and ability to travel throughout the community to various locations

• US work authorization

Strongly Preferred

• Fluency in language that is commonly spoken in the community when necessary. Most often this will include Bilingual English/Spanish

• Experience working on multidisciplinary teams with organizations, agencies, patients, and community members

• Knowledge of community resources and resource navigation

Preferred

• Community Health Worker certification or Associates or Bachelors in a related field is a plus

• Experience utilizing electronic medical record systems

Other Skills

• A problem-solving orientation and a flexible and positive attitude

• Someone who embodies being 'Oaky'