Find & Apply For Patient Advocate / Navigator Jobs in Paoli, Indiana

Maternal and Infant Health

COMMUNITY HEALTH WORKER JOB DESCRIPTION DEPARTMENT

Outreach

REPORTS TO

:

Maternal and Infant Health Navigator/Coordinator or Program Manager Travel:

Local travel may be required for community outreach, community visits, partner meetings, and patient support activities.

Grant Funded:

Yes Grant Period:

Position is grant-funded and subject to grant requirements, continued funding, organizational needs, and applicable grant timelines.

POSITION SUMMARY

The Maternal and Infant Health Community Health Worker (CHW) serves as a trusted bridge between pregnant and postpartum patients, infants and families, the healthcare system, and community resources. Working as an integral member of the maternal and infant health team, the CHW provides culturally responsive, patient-centered, trauma-informed outreach, education, advocacy, and support to individuals and families throughout pregnancy, the postpartum period, and early infancy. The CHW helps patients and families overcome barriers that may prevent them from receiving timely healthcare and social services. The position builds trusting relationships with patients, assists families in identifying their goals and needs, connects them with appropriate resources, provides approved health education, supports appointment engagement, and follows up to determine whether identified needs have been addressed. The CHW does not independently provide clinical care or perform duties outside of the individual's training, certification, or scope of practice. The CHW instead works closely with nurses, providers, care coordinators, behavioral health staff, social workers, patient navigators, and other members of the interdisciplinary care team. The CHW will support the organization's Grow Grant goals and measurable outcomes by helping improve access to prenatal care, postpartum care, infant preventive care, social services, health education, and community-based resources.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES 1.

Patient and Family Engagement Establish and maintain trusting relationships with pregnant individuals, postpartum patients, infants, parents, caregivers, and families. Serve as a consistent and supportive point of contact for assigned patients. Engage patients using respectful, nonjudgmental, culturally responsive, and trauma-informed communication. Meet patients where they are and recognize individual strengths, priorities, preferences, and circumstances. Encourage patients to participate actively in their healthcare and identify their own goals. Provide ongoing encouragement and support throughout the maternal and infant health journey. Help patients feel comfortable communicating questions and concerns to their healthcare team. Build relationships with patients who may have previously experienced barriers or difficulty engaging with healthcare systems. 2. Social Determinants of Health Support The CHW will help identify and address social and environmental barriers that may affect maternal and infant health.

Potential needs include:

Food insecurity. Housing instability. Transportation. Utility assistance. Insurance coverage. Childcare. Employment or financial concerns. Clothing and infant supplies. Access to technology or communication. Language barriers. Social isolation. Access to behavioral health resources. Access to substance-use services. Family safety concerns. Other basic needs.

The CHW will:

Assist with approved screenings. Discuss identified needs with the patient. Provide information about available resources. Make appropriate referrals. Assist patients with completing applications when permitted. Follow up regarding resource connections. Document services provided. Escalate urgent or high-risk concerns according to organizational policy. 3. Community Resource Navigation The CHW will maintain knowledge of community programs and resources serving pregnant individuals, infants, children, and families.

Resources may include:

WIC. Public health programs. Food assistance programs. Housing assistance. Utility assistance. Transportation programs. Childcare resources. Early Head Start and Head Start. Early intervention programs. Home visiting programs. Behavioral health organizations. Substance-use treatment programs. Domestic violence resources. Parenting programs. Maternal health organizations. Infant support programs. Faith-based and community organizations. Other local social service agencies. The CHW will provide patients with accurate information and help facilitate connections when appropriate. 4. Referral Support The CHW will assist patients in successfully accessing referrals and community services.

Responsibilities include:

Explain the purpose of the referral in understandable language. Provide patients with contact information and instructions. Assist with scheduling when appropriate. Identify barriers to completing referrals. Help patients understand what they need to do to access services. Follow up after referrals. Document referral-related activities. Notify the appropriate care team member when a referral has not been completed or additional assistance is needed. The CHW will not make clinical determinations regarding the appropriateness of a medical referral. 5. Patient Advocacy The CHW serves as a patient advocate within the boundaries of the position.

Responsibilities include:

Listening to patient concerns. Helping patients communicate questions to the healthcare team. Helping patients understand available services. Supporting informed participation in care. Identifying barriers that may prevent patients from accessing services. Helping patients identify potential solutions. Supporting patients who may have difficulty navigating healthcare systems. Respecting patient choices and self-determination. The CHW does not make medical decisions or provide medical advice outside of approved training and organizational protocols. 6. Outreach and Community Engagement The CHW may participate in community-based outreach activities designed to increase awareness of maternal and infant health services.

Activities may include:

Community health fairs. Health education events. Outreach events. Partner organization events. School or early childhood events when appropriate. Community presentations. Enrollment or resource events. Maternal and infant health awareness activities. Distribution of approved educational materials. Relationship-building with community organizations. The CHW will represent the organization professionally and consistently with organizational policies. 7. Community When included within the Grow Grant program model, the CHW may conduct approved community Activities During these visits, the CHW may: Provide approved education. Assess non-clinical barriers to care. Connect families to community resources. Assist with appointment engagement. Provide resource information. Support care-plan follow-through. Follow up on previously identified needs. Document the visit and services provided. 8. Care Team Collaboration The CHW will work closely with the interdisciplinary care team.

This includes collaboration with:

Maternal and Infant Health Navigator/Coordinator. Nurses. Providers. Medical assistants. Behavioral health staff. Patient access/registration staff. Community partners. Other members of the healthcare team.

The CHW will:

Participate in team meetings and huddles. Provide appropriate updates regarding patient barriers. Communicate completed interventions. Identify patients requiring additional assistance. Participate in case review when requested. Support warm handoffs. Maintain appropriate professional boundaries. Escalate concerns promptly. 9. Documentation The CHW is responsible for accurate and timely documentation of services provided.

Documentation may include:

Patient outreach attempts. Successful patient contacts. Community activities. Education provided. Social needs identified. Resources provided. Referrals made. Referral follow-up. Appointment assistance. Transportation assistance. Care coordination activities. Patient goals. Barriers to care. Outcomes of interventions. Grant-required program activities. Documentation must be completed according to organizational standards and within required timeframes. 10. Electronic Health Record and Technology The CHW will use the organization's electronic health record and approved technology systems to support patient care and grant activities.

Responsibilities may include:

Entering patient contacts. Recording outreach attempts. Documenting interventions. Updating appropriate information. Reviewing assigned worklists or reports. Tracking follow-up activities. Using approved communication systems. Completing grant-related tracking requirements. The CHW must protect patient information and follow all HIPAA, privacy, cybersecurity, and organizational requirements. 11. Grow Grant Responsibilities The CHW will actively support the organization's Grow Grant objectives.

Responsibilities include:

Understanding the purpose and goals of the Grow Grant. Completing grant-funded activities as assigned. Meeting established outreach expectations. Supporting patient engagement goals. Completing required documentation. Tracking assigned program activities. Supporting collection of grant-required information. Participating in program meetings. Participating in quality improvement activities. Identifying barriers that affect program participation. Providing feedback regarding patient and community needs. Supporting grant performance measures. The CHW is responsible for ensuring that work performed under the grant is properly documented and attributable to the approved program. 12. Patient Follow-Up Consistent follow-up is a core responsibility of the CHW. The CHW will follow up with patients regarding: Missed appointments. Referrals. Community resources. Transportation. Social needs. Prenatal care. Postpartum care. Pediatric care. Health education. Hospital or emergency department follow-up. Other identified patient goals. The CHW will document the outcome of follow-up efforts and escalate unresolved barriers as appropriate. 13. Cultural and Linguistic Responsiveness The CHW will provide culturally responsive services and recognize the diversity of the patients and communities served.

The CHW will:

Respect cultural beliefs and practices. Use plain language. Respect patient preferences. Avoid stigmatizing language. Practice trauma-informed communication. Support patients in identifying their own goals. Use qualified interpreter services according to organizational policy. Recognize how culture, socioeconomic conditions, transportation, housing, and other factors may influence healthcare access. Bilingual ability, particularly English/Spanish , is preferred and may be required based upon the population served. 14. Trauma-Informed and Strengths-Based Approach The CHW will interact with patients using principles of trauma-informed care.

This includes:

Building trust. Promoting safety. Providing choices whenever possible. Avoiding judgment. Recognizing patient strengths. Supporting patient autonomy. Maintaining appropriate boundaries. Avoiding re-traumatization. Recognizing when a patient needs additional professional support. The CHW should focus on what the patient and family can do and what resources can help them succeed , rather than solely focusing on barriers. 15. Safety and Escalation The CHW must recognize situations that require immediate assistance from clinical or leadership staff.

The CHW will promptly escalate:

Medical emergencies. Behavioral health emergencies. Threats to patient or staff safety. Suspected abuse or neglect. Domestic violence or other safety concerns. Significant changes in patient condition reported during contact. Urgent social needs. Other situations outside the CHW's role or scope. The CHW is not expected to independently manage clinical emergencies. 16. Community Partnerships The CHW will help establish positive working relationships with organizations that support maternal and infant health.

The CHW may:

Maintain knowledge of local resources. Provide community resource information. Participate in community partner meetings. Support referral relationships. Identify gaps in community resources. Communicate changes in community resource availability. Provide feedback regarding patient experiences accessing community services. 17. Program Improvement The CHW will contribute frontline knowledge to improve the Grow Grant program. The CHW is encouraged to identify: Recurring patient barriers. Gaps in community services. Problems with referral processes. Appointment access issues. Communication barriers. Transportation challenges. Opportunities to improve patient engagement. Opportunities to improve patient education. Other system-level issues affecting maternal and infant health. The CHW will communicate these observations to the Navigator/Coordinator or supervisor.

REQUIRED QUALIFICATIONS

Education Minimum:

High school diploma or equivalent.

Preferred:

Associate's or bachelor's degree in: Public Health. Community Health. Social Work. Human Services. Maternal/Child Health. Psychology. Sociology. Healthcare. Nursing. Or another related field. Equivalent experience may be considered in accordance with organizational policy.

EXPERIENCE

Required Experience working with patients, families, community members, or vulnerable populations. Experience providing community support, outreach, education, social services, customer service, or related services. Preferred Experience working in a healthcare setting. Experience in an FQHC or community health center. Experience working with pregnant individuals, mothers, infants, children, or families. Experience as a Community Health Worker. Experience with patient navigation. Experience addressing social determinants of health. Experience working with Medicaid or uninsured populations. Experience with community outreach. Experience working with social service agencies. Experience with grant-funded programs. Experience documenting services in an electronic health record.

COMMUNITY HEALTH WORKER CERTIFICATION A

current Community Health Worker certification is preferred or required based upon organizational and/or grant requirements. If certification is not held at the time of hire, the employee may be required to complete an approved CHW training or certification program within a specified period following employment. Additional maternal and infant health, perinatal, breastfeeding, parenting, or other relevant training may be encouraged or required based upon program needs.

KNOWLEDGE, SKILLS, AND ABILITIES

The successful candidate will demonstrate: Relationship Building Ability to establish trust with patients and families. Ability to work with individuals experiencing significant barriers. Strong interpersonal skills. Empathy and patience. Communication Excellent verbal communication. Strong listening skills. Ability to communicate using plain language. Ability to communicate effectively with diverse populations. Ability to maintain appropriate professional boundaries. Community Knowledge Understanding of local community resources. Ability to identify appropriate resources for individual patient needs. Ability to develop relationships with community organizations. Organization Ability to manage multiple patients and follow-up activities. Strong attention to detail. Ability to meet deadlines. Ability to maintain accurate documentation. Technology Basic computer proficiency. Ability to learn electronic health record systems. Ability to use email, electronic communication, and Microsoft Office or comparable systems. Ability to learn grant tracking and reporting systems. Problem Solving Ability to identify barriers. Ability to help patients develop practical solutions. Ability to recognize when issues need to be escalated. Teamwork Ability to work effectively with clinical and non-clinical team members. Ability to participate in interdisciplinary care. Ability to accept direction and feedback.

CORE COMPETENCIES 1.

Patient-Centered Care Treats patients and families with dignity, respect, compassion, and empathy. 2. Community Connection Understands the community and connects patients with meaningful resources. 3. Accountability Takes responsibility for completing assigned outreach, follow-up, documentation, and program activities. 4. Communication Communicates clearly, respectfully, and consistently. 5. Collaboration Works effectively with clinical teams, organizational staff, and community partners. 6. Cultural Responsiveness Recognizes and respects differences in culture, language, beliefs, and family circumstances. 7. Reliability Follows through on commitments to patients and coworkers. 8. Adaptability Responds positively to changing patient, program, and organizational needs. 9. Confidentiality Protects patient information and follows HIPAA and organizational privacy requirements. 10. Advocacy Helps patients identify and overcome barriers while respecting patient choice and autonomy.

KEY PERFORMANCE EXPECTATIONS

Performance may be evaluated based upon the CHW's ability to: Successfully engage assigned patients and families. Maintain consistent and timely patient follow-up. Complete assigned outreach activities. Support prenatal and postpartum care engagement. Support infant preventive care engagement. Connect patients with appropriate community resources. Follow up on referrals and identified social needs. Maintain accurate and timely documentation. Meet applicable Grow Grant program requirements. Participate effectively as a member of the interdisciplinary care team. Demonstrate appropriate escalation of clinical, behavioral health, and safety concerns. Maintain patient confidentiality. Demonstrate respectful and culturally responsive communication. Identify recurring barriers and contribute ideas for program improvement. Maintain professional relationships with patients, families, coworkers, and community partners.

SAMPLE PERFORMANCE MEASURES

Specific measures should be established by the Grow Grant program and organizational leadership.

Potential measures include:

Patient Engagement Number of assigned patients. Number of successful patient contacts. Percentage of assigned patients successfully engaged. Outreach attempts completed. Follow-up contacts completed. Care Engagement Prenatal care appointments supported. Postpartum appointments supported. Pediatric appointments supported. Missed appointments followed up. Hospital/ED follow-up completed. Social Needs Social needs screenings completed. Social needs identified. Resource referrals provided. Referrals successfully connected. Follow-up completed. Education Maternal health education contacts. Infant health education contacts. Parenting/infant resource connections. Community education activities. Documentation Timeliness of documentation. Completeness of required documentation. Accuracy of grant-related data. 30/60/90-DAY

EXPECTATIONS

First 30 Days — Learn The CHW will: Complete organizational orientation. Complete required compliance and HIPAA training. Complete CHW-specific training. Learn Grow Grant goals and requirements. Learn maternal and infant health workflows. Learn the organization's EHR. Learn documentation expectations. Become familiar with local community resources. Meet members of the interdisciplinary care team. Review safety and escalation procedures. Days 31-60 — Engage The CHW will: Begin active patient outreach. Begin supporting assigned patients. Conduct resource and referral activities. Participate in care team meetings. Demonstrate appropriate documentation. Begin building relationships with community partners. Demonstrate appropriate escalation of patient concerns. Meet established introductory productivity expectations. Days 61-90 — Own The CHW will: Independently manage assigned outreach responsibilities. Maintain consistent patient follow-up. Demonstrate effective community resource connections. Meet established documentation standards. Demonstrate understanding of Grow Grant requirements. Participate in quality improvement activities. Identify recurring barriers affecting patients. Demonstrate effective collaboration with the Navigator/Coordinator and clinical team.

DIFFERENCE BETWEEN CHW AND MATERNAL & INFANT HEALTH NAVIGATOR/COORDINATOR

The CHW and Navigator/Coordinator should work as a team but have distinct responsibilities. Maternal & Infant CHW Maternal & Infant Navigator/Coordinator Builds patient relationships Coordinates the overall program/caseload Conducts outreach Oversees navigation workflows Provides non-clinical education Coordinates interdisciplinary services Identifies social needs Tracks referral completion Connects patients to resources Manages complex coordination Provides hands-on patient support Monitors program performance Conducts community engagement Supports grant reporting Performs follow-up Reviews program data Supports appointment engagement Addresses workflow/system barriers Reports barriers to team Leads coordination and escalation Documents patient interactions Oversees documentation/data quality Provides frontline community insight Supports quality improvement and program management In simple terms: The CHW builds the relationship and walks alongside the patient. The Navigator/Coordinator makes sure the overall system works around the patient. This distinction will help prevent duplication of work and will make the Grow Grant staffing model much easier to manage and measure.

PHYSICAL AND WORK ENVIRONMENT

The position may require work in: Clinic settings. Community locations. Partner organizations. Community events. Patient homes when authorized. Other locations necessary to accomplish program objectives. The employee must be able to: Communicate effectively in person and by telephone. Use a computer and electronic health record. Travel locally as required. Sit, stand, and walk for extended periods. Carry program materials and supplies as needed. Work independently in community settings. Maintain appropriate professional boundaries. Reasonable accommodations will be considered in accordance with applicable law.

CONFIDENTIALITY AND COMPLIANCE

The employee must comply with: HIPAA, Organizational privacy and confidentiality policies, Organizational compliance requirements, Applicable federal and state laws, Grant requirements, Documentation requirements, Information security policies, Patient safety policies, Employee conduct standards, Applicable CHW standards and certification requirements.