Community Health Worker

Job Details

Job Description

The Community Health Worker (CHW) will assist individuals and communities to adopt healthy behaviors. The CHW will help patients and their families navigate and access community resources and services. The CHW will provide support to the selected practice care coordinators and clinicians through a team based care model. The CHW will provide social support, informal counseling, education on the various community resources and services, and advocate for individual and community health needs. The CHW will be a liaison between the patient/families and community service agencies. Home and community-based visits are work assignment specific but could be an essential function of a CHW's work.

ESSENTIAL FUNCTIONS:

* Manages caseload of patients/community members and completes outreach and follow up as needed

* Assists in developing and implementing care plans in cooperation with patients/community members, families, and healthcare team with appropriate follow up and completes accurate, timely documentation.

* Responsible for building trusting relationships with patients/community members and their caregivers through engagement, collaboration, advocacy, decision making and problem-solving activities

* Identifies social needs through behavioral health, social determinants of health, and HRSN screenings and provides guidance, supports enrollment and navigate eligible individuals in federal, state, and local private or nonprofit/social service, health and human services programs, and SCD community-based organization partners

* Provides culturally and linguistically appropriate health education materials within the scope of training

* Assists patients and families/caregivers in effectively communicating with their health care team, understanding and carrying out their healthcare clinicians' advice, and communicates to care team any changes in plan or medical condition

* Provides referral, follow-up services and schedule patient appointments as needed

* Work in community and hospital settings, or other designated settings, to ensure that the patients' needs are properly identified. This will include, but not limited to, home visitations, hospital visits, ED visits, other medical appointments and all other approved locations to work efficiently with the patient to provide stability

* Working with sickle cell transition population to ensure all patient needs from pediatric to adult care have been accessed. This includes attending appointments, assisting with benefits, participating in community transition events, meetings and grant projects related to transition.

* Attending support group meetings for sickle cell patients and outside activities relevant to education and socialization.

* Interacts with co-workers, visitors, and other staff consistent with the iSCORE values of Jefferson

Work Shift

Worker Sub Type

Primary Location Address

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.