Lead Community Health Worker
Job Summary:
The Lead Community Health Worker is responsible for exemplifying The University of Texas Health Science Center’s (UTHSCT) Mission, Vision and Values, providing outstanding customer service. The Lead Community Health Worker (CHW) will function as a member of a multidisciplinary team that conducts patient/family support to help patients achieve good health practices, and/or community outreach. Primary responsibilities include facilitation of health improvement, health promotion, health program development and support, health prevention activities, and coordination with regional programs and other partners within the community. This position works closely with assigned leadership and reports directly to the Manager assigned. Performs other related duties as required/assigned.
Major Responsibilities / Duties / Critical Tasks:
- Speak with diverse populations about health programs in a sensitive and culturally competent manner.
- Speak to community groups/organizations to promote healthy lifestyle activities.
- Provide one-on-one education on disease and encourage self-management skills with patients and community members.
- Assess and assist patients for potential eligibility for grants, programs, and/or community resources.
- Assist clients in completion of forms/applications required to receive needed services or as required by referral agencies
- Research individual patient medical record and identify needed health maintenance and/or chronic disease management items and enter data on pre-visit planning note for nursing and provider review and follow-up.
- Facilitate and follow-up on patient referrals to Psychology Department as assigned.
- Act as a health coach for patients to achieve desired health behaviors.
- Provide families with referrals to community resources (such as food pantries) as needed.
- Assist with development, improvement, and standardization of processes and guidelines for population health measures.
- Maintain data records and files for patient records and program reporting as designated.
- Teach and mentor team members on requirements, processes, and guidelines for population health measures.
- Complete timely documentation and required reporting for all services provided in the PSC/CHW template.
- Assist patients in obtaining medical records from outside facilities.
- Review and enter results from outside physicians/facilities into the electronic health record.
- Conduct patient home visits when necessary i.e.., follow-up, health education, application assistance, etc.
- Assist patients with patient portal registration and questions. Utilize patient portal for communication, education, and reminders.
- Coordinate with direct supervisor and/or assigned leadership regarding educational and outreach events focusing on project goals and requirements.
- Participate in community outreach and assist clinical staff with health screenings in the community.
- Complete annual Texas Community Partner Program and Health Insurance Marketplace training and assist patients with annual enrollment, re-enrollment, and special enrollment periods.
- Establish and maintain working relationships with internal and external partners.
- Handle administrative functions to promote, coordinate, collaborate, and support the scope of work required to achieve stated goals.
- Use excellent oral and written communication skills to prepare memos, formal correspondence, acknowledgements, notes, and reports to efficiently and effectively interact with team members, internal and external partners to accomplish essential tasks.
- Coordinate, facilitate, and/or participate in regular and/or special meetings.
- Comply with hospital and legal requirements by fostering practices that adhere to the hospitals and nursing division’s philosophy goals, and standards of care.
- Respect patients by recognizing their rights, privacy, and maintaining confidentiality
- Maintain quality service by establishing and enforcing organization standards.
- Contribute to team effort by accomplishing related results as needed.
- Collaborate with clinic nursing staff and providers to promote population health.
- Print med sheets for nurses and mark Health Maintenance items needed on sticker, as assigned.
- Sort, locate, and document faxes on health maintenance records at least once a day.
- Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies.
- Demonstrate a high level of understanding of HIPAA.
- Handle all phone calls, emails, and in person interactions cordially and professionally.
- Other duties as assigned.
Accompanying Knowledge, Skills, Abilities and Competencies:
- Other duties as assigned.
- Knowledge and experience in preventative care guidelines
- Knowledge of community resources and experience working with a variety of community-based organizations.
- Experience with care coordination or case/care management.
- Bilingual a plus.
- EMR experience.
- Motivational interviewing skills.
- Strong interpersonal skills
- Strong oral and written communication skills
- Strong organizational and time management skills
- Flexibility.
- Ability to work independently in an ambiguous environment; proactive
- Standard hospital/clinic related office equipment.
- Working knowledge of Microsoft Office Products.
- Strong knowledge of Medicaid, Medicare, Managed Care, and Private Insurance.
Required Education / Experience:
- High School Diploma or GED required.
- At least two years’ experience in health care/clinical or equivalent health-related education required
- Community Health Worker certification by Texas Department of State Health Services. Must maintain current certification.
- CPR/Heartsaver preferred or obtained within 3 months of hire. Must maintain current CPR certification.
- Current Texas Community Partner Program training by Health and Human Services preferred or obtained within 3 months of hire. Must maintain current training.
- Current Health Insurance Marketplace training preferred or obtained within 3 months of hire. Must maintain current training.