Lead Community Health Worker

Benefits:

• 401(k)
• Health insurance

Job Summary

The Community Health Worker (CHW) Lead provides daily guidance to the CHW team, supporting person-centered services for Medi-Cal members. The Lead coordinates workflows, coaches staff, reviews service documentation, and ensures member needs are resolved. This role bridges CHW services with Enhanced Care Management (ECM), Community Supports (CS), Intake, and community partners.

Leadership and Scope of Authority


Supervise assigned CHWs, exercising authority over scheduling, performance evaluations, and corrective actions in coordination with the Program Manager and HR. Maintain a personal caseload of up to 10 active members while balancing supervision and quality reviews. Licensed clinical consultants review and approve care plans, while the designated Medi-Cal supervising provider retains responsibility for CHW qualifications and claims. This role does not authorize diagnosis, clinical care-plan approval, or clinical supervision.

Essential Responsibilities

1. Guide daily work and staff performance: Approve schedules, coordinate coverage, assign priorities, and conduct evaluations. Provide coaching and issue documented corrective actions per HATS policies in coordination with HR and leadership.
2. Monitor caseloads and continuity of services: Review caseloads weekly to verify intake assessments, active goals, next steps, and follow-up dates. Address overdue contacts and referrals, and manage coverage and transfers.
3. Support member engagement and progress: Provide culturally responsive, trauma-informed CHW services primarily in person. Support non-clinical health education, navigation, individual advocacy, and screenings while respecting member choice and privacy.
4. Coordinate eligibility and required approvals: Verify Medi-Cal eligibility and authorizations with Intake. Ensure care plans are reviewed by clinical consultants. For CPT codes 98960–98962, ensure care plans exceeding 12 units/year undergo semi-annual provider review and do not exceed one year in duration.
5. Review documentation and resolve deficiencies: Complete service notes within 24–48 hours of encounters and audit team compliance for required details. Track note corrections, preserve audit trails, and coach staff on documentation errors.
6. Support compliant billing and audit readiness: Collaborate with billing staff and supervising providers to address unit discrepancies, denials, and duplicate claims. Apply coding standards; note that text, email, and chat are non-reimbursable visits.
7. Coordinate ECM and Community Supports referrals: Coordinate warm handoffs with Intake, ECM, and CS teams. Verify ECM enrollment dates to avoid duplicate billing during active enrollment and ensure proper program authorizations.
8. Train staff and maintain readiness: Lead onboarding, shadowing, and workflow training. Maintain CHW qualification records, verify completion of at least 6 hours of annual continuing education, and communicate policy updates.
9. Report results and address service barriers: Maintain accurate trackers and report key engagement, documentation, and referral metrics to the Program Manager. Identify recurring workflow issues and recommend process improvements.
10. Protect member information and respond to concerns: Uphold confidentiality, safety, and professional boundary standards across settings. Escalate urgent clinical or behavioral safety concerns, privacy issues, and member complaints promptly.

Qualifications and Skills

• Required: Valid CHW Certificate of Completion meeting Medi-Cal requirements and ongoing annual training compliance.
• Required: Lived experience connecting to the target community/population served per Medi-Cal standards.
• Proven experience in CHW navigation or community health, with demonstrated coaching and organizational skills.
• Preferred: Bachelor's or Master's degree in public health, social work, human services, or healthcare field.
• Strong knowledge of CHW scope, documentation rules, confidentiality, and CalAIM/Medi-Cal managed care programs.
• Professional communication skills and proficiency with electronic health records and office software.
• English fluency required; bilingual skills (English/Spanish) and strong cultural humility preferred.

Performance Expectations


The Lead is expected to monitor and report on team performance targets, including:

• Timely member follow-up, completed assessments, caseload management, and personal caseload limit of 10 members.
• Completion of service notes within 24–48 hours, care plan updates, authorizations, and clinical reviews.
• Referral closure rates and member goal achievements.
• Staff onboarding milestones and annual training compliance.
• Identification and resolution of recurring service or operational barriers.