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Job Description
ECM Community Health Worker (Case Management) Inland Housing Solutions - 2.0 San Bernardino, CA Job Details Full-time $25 - $29 an hour 6 days ago Benefits Health insurance Dental insurance Paid time off Vision insurance Flexible schedule Life insurance Qualifications Computer operation Teamwork Computer literacy Trauma-sensitive environment English High school diploma or GED Driver's License Cultural competency Working with individuals from diverse cultural backgrounds Computer skills Working with individuals from underserved communities Full Job Description At Inland Housing Solutions, relationships are the foundation of effective care. Our Enhanced Care Management (ECM) team walks alongside Medi-Cal individuals, families, and child/youth members experiencing homelessness, medical, social, and behavioral health challenges — meeting them where they are with compassion, cultural competence, and trauma-informed practice to improve health outcomes. The Community Health Worker (CHW) is designed for individuals passionate about serving vulnerable populations through community and public health initiatives. Specific to California's CalAIM ECM program the CHW coordinates various aspects ofb patient care, focusing on improving patient outcomes through effective engagement and managing a caseload based on patient needs and preferences. This office and field-based role works as part of the ECM team with high-volume outreach, member advocacy, appointment scheduling, transportation coordination, resource connections, and follow-up tasks to improve members' health outcomes. Under the direction of the ECM Program Manager, the CHW works collaboratively with members, families, healthcare professionals, community resources, and the interdisciplinary team to deliver seamless Whole-Person Care and connect individuals to essential medical, behavioral health, and social supports. Candidates ideally should have prior knowledge and work experience with ECM (CalAIM) programs. This role provides culturally relevant connections to healthcare and addresses Social Drivers of Health (SDOH) by assisting members with chronic disease management, community supports, behavioral health needs, preventive services, and healthcare navigation. Services are informed by the CHW's lived experience within their community. This role will involve telephonic outreach and/or case management and may require in-home visits. It is not a remote position.
Role and Responsibilities Member Engagement & Support:
Build trust and serve as a friendly reliable point of contact for members using evidence-based approaches, such as Motivational Interviewing to help explore and address medical, social, behavioral needs, guide clinical interventions, promote collaboration with their medical and behavioral health teams, and refer/escalate to Behavioral Health, RN, or other team members based on member choice and acuity. Support high-risk or low-engagement members with tailored outreach and follow-up strategies that are warm, trauma-informed and culturally responsive. Ensure members receive services that honor cultural preferences, health literacy levels, and family dynamics. Assist members in navigating the healthcare system, understanding their care plans, obtaining community supports, overcoming barriers to accessing care, and participating successfully in their treatment plans. Conduct visits as determined by the member's care plan and/or meet members where they are (e.g. homes, physician offices, hospitals, restaurants, homeless encampments, or other community locations). Monitor and maintain targeted lists on an ongoing basis to ensure appropriate follow-up and continuity of care with proactive phone and in-person outreach.
Care Coordination & Team Support:
Provide advocacy on behalf of ECM Members in the home, the community, and in provider organizations. Assist Lead Care Managers with daily tasks: scheduling appointments, arranging transportation, referral coordination, and connecting members to housing, benefits, behavioral health, and community resources. Consult with RN and/or Behavioral health Specialist before taking any interventions that are clinical in nature Collaborate and share Member care issues or barriers with other team members and participate in weekly ad hoc case reviews as well as Interdisciplinary Care Team (ICT) meetings, weekly huddles, and reflective supervision to improve outcomes. Provide timely updates to PCPs, clinics, hospitals, and referral partners on member progress, barriers, appointment attendance, and care-plan goals.
Provider and Partner Relations:
Build and maintain positive working relationships with healthcare providers through office visits, phone, email, and fax communications. Provide information on ECM member benefits and services to providers and community partners.
Documentation & Compliance:
Ensure and complete documentation in required platforms (CRM, EHRs, Spreadsheets, etc.) is accurate, useful, timely and in compliance with regulatory or mandated reporter requirements and standards. Accurately document all activities in Customer Relationship Management platform, EHR, and other required systems (including double documentation when required) while protecting PHI in accordance with HIPAA. Attend required staff meetings, trainings, and compliance activities. Maintain confidentiality, boundaries, and ethical decision-making at all times.
Growth & Professional Development:
Begin by supporting the team's larger caseloads, then progressively take on an independent caseload under close supervision; collaborate on person-centered car e plans and regularly update goals, interventions, and barriers.
Other:
Perform other duties as needed. Required Qualifications High School Diploma or equivalent Strong desire to work with and meaningfully serve vulnerable populations. Commitment to learning and delivering trauma-informed, culturally competent, and patient-centered care. Comfortable with different technologies. Adaptable and willingness to learn. Proficient computer skills and willingness to master multiple documentation systems Valid California driver's license Clean driving record Reliable insured vehicle Comfortable traveling throughout Riverside and San Bernardino Counties. Ability to pass background check and drug screen. Exceptional interpersonal, communication and collaborative skills, with the ability to work effectively within a multidisciplinary team. Preferred Qualifications Experience in Medical Records (EMR) such as Epic or similar. CHW Certification Prior outreach, case management, or customer-service experience (even non-ECM) Bilingual English/Spanish Any previous exposure to Medi-Cal, CalAIM, or Enhanced Care Management or experience in the Medical Field (e.g. Public Health, Community Health, Medical Assistant, CNA, LVN) Physical Requirements and Work Environment Must be able to sit for long periods of time. Normal range of hearing and vision. Regularly required to operate a computer keyboard, mouse, telephone, reach with hands and arms. Must be able to lift up to 25 lbs. at a time. Regular, planned travel required for community-based visits and work in the office. At IHS we are people advocates. We recognize that individuals come from all walks of life, have different circumstances, or may even have a disability. The strength of our organization is our employees. By uniting diverse cultures, backgrounds, personalities, strengths, and lived experiences, we can continue building a team of exceptional talents and perspectives that can deliver relevant high-quality services while effectively meeting clients where they are. We are committed to creating a workplace where all employees, regardless of background, or characteristics, are engaged, feel they belong, and can grow and develop long careers with our organization. We welcome you to apply!
Job Type:
Full-time Pay:
$25.00 - $29.00 per hour
Benefits:
Dental insurance Flexible schedule Health insurance Life insurance Paid time off Vision insurance Application Question(s): Are you available to perform home visits?
License/Certification:
Driver's License (Required) Community Health Worker Certificate (Required)
