Community Health Worker (CHW) - Enhanced Care Management

Job Summary We are seeking a compassionate and skilled Community Health Worker (CHW) to join our team in providing enhanced care management services to our patients. As a CHW, you will play a vital role in improving the health and well-being of individuals and families in our community. You will work closely with patients, families, and healthcare providers to deliver high-quality, patient-centered care that addresses the physical, emotional, and social needs of our patients. This position involves frequent travel to the

RCMS FQHC

in Gualala to provide in-person assistance to clients.

Responsibilities:

1. Conduct patient assessments to identify health and social needs. 2. Develop personalized care plans in collaboration with patients, families, and healthcare providers. 3. Provide education and support on chronic disease management, healthy behaviors, and self-care. 4. Facilitate access to community resources, services, and referrals. 5. Coordinate care transitions and communicate with healthcare providers. 6. Conduct regular home visits and phone follow-ups to monitor progress. 7. Document patient interactions, and care plans in electronic health records within 24 hours and close all encounters. 8. Collaborate with interdisciplinary teams to address patient needs and improve health outcomes. 9. Identify and address social determinants of health and health disparities. 10. Provide cultural competency and linguistically appropriate services. 11. Maintain patient confidentiality and adhere to HIPAA guidelines. 12. CHW minimum productivity is expected to be 80% clinical (patient billable encounters) and 20% Non-productive (driving/documentation/outreach etc.). 13. Schedule 75% of clients before the 15th of each month. 14. Conduct outreach for community awareness of the ECM program. 15. Attend regular staff meetings, trainings, and other meetings, as requested.

NON-ESSENTIAL DUTIES AND RESPONSIBILITIES

Performs other duties as assigned. Ability to work independently and be self-directed and flexible. Ability to perform functions with minimal supervision. Ability to work at a high-volume level of accuracy.

Requirements:

1. A bachelor's degree in psychology, social work, human services, or a related field. 2. Community-based work or in-vivo work is required with proper safety precautions. 3. Certification as a CHW (CCHW) or willingness to obtain within 18 months. 4. CPI and CPR within 60 days of hire. 5. Strong communication, interpersonal, and cultural competency skills. 6. Ability to work independently and as part of a team. 7. Basic computer skills and familiarity with electronic health records. 8. Valid driver's license and reliable transportation (if applicable).

Preferred Qualifications:

1. Certified as a CHW (CCHW) 2. Experience working with diverse populations and communities. 3. Knowledge of community resources and services. 4. Familiarity with care management software and technology. 5. Bilingual or multilingual skills.

Working Conditions:

1. Office and Community-based setting with frequent travel to client homes, community organizations, and healthcare providers. 2. Travel to Gualala on Mondays, Wednesdays, and Fridays, stationed at

RCMS FQHC. 3.

Flexible scheduling to accommodate client needs, including evenings and weekends.

Pay:

$24.00 - $28.00 per hour

Benefits:

Dental insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

Hybrid remote in Ukiah, CA 95482