Community Health Worker - Street Medicine
- Maintains situational awareness and ensures scene safety when providing services in the community
- Conducts community outreach and establishes trusting relationships with patients while providing general support and encouragement
- Manages and provides ongoing follow-ups to an assigned caseload of patients including:
- Schedules patient appointments and encounter patients using EMR Registration program
- Uses basic motivational interviewing and goal setting
- Conducts phone calls, home or living environment visits, and visits to other settings where patients are located
- Assists patients attend appointments through assessing and addressing access barriers
- Provides referrals for services to community agencies as appropriate
- Assists patients connect with transportation resources and provides appointment reminders, as needed
- Assists patients with completing applications and registration forms
- Conducts eligibility determination, enrollment, and follow up with uninsured patients
- Liaises between patients and community service agencies to ensure patient needs and rights are met, including collaborates with community providers to ensure continuity of care
- Assists patients in navigating the healthcare system by finding and following up by phone and in-person with eligible ECM patients
- Documents and shares patient barriers with ECM team and PCP to improve care and outcomes
- Utilizes evidence-based approaches when engaging with patients to increase their sense of control over their health, such as motivational interviewing to promote collaboration between patients and their medical/behavioral care team
- Communicates and delivers easy to read information about health and wellness to the community and provides information on ECM patient benefits and services
- Advocates on behalf of ECM patients in the home or their living environment to community and provider organizations
- Builds and maintains a positive working relationship with providers, including interactions within provider offices, phone, email, fax, and other approved communication methods
- Assists the ECM team and providers to understand the culture, norms, beliefs, and preferences about patients and their communities by representing the community's voice
- Helps create messages and materials that fit community culture and delivers messages to fit the culture of patients
- Works collaboratively within the ECM team to discuss responsibilities, task sharing, conflict resolution, and patient case reviews
- Collaborates on patient care issues with other ECM team patients
- Participates in weekly case reviews and consults with the patient's PCP before taking any clinical action
- Ensures documentation is accurate, helpful, and compliant with regulatory requirements and accreditation standards, including recording required documentation in eCW and managed care plans ECM portal within one day
- Participates in required staff meetings or other activities, as assigned
- High school/GED required
- Current Basic Life Support (BLS) certification is required upon hire and must be maintained as a condition of employment. These courses must follow AHA guidelines, but may be completed through approved online providers such as ProMed or other equivalent programs that meet recognized BLS standards.
- Two years’ healthcare, behavioral health, street medicine, or social services industry experience required
- Valid CA Driver’s License and proof of auto insurance required
- Experience working with unsheltered homeless and/or personal lived homelessness experience preferred
- Experience working in outreach and customer service within the medical office and behavioral health environments with individuals who struggle with substance use disorder and mental health issues preferred
- Bilingual (English/Spanish) preferred
- Knowledgeable about and experience with numerous cultural issues, such as immigration, socioeconomic, LGBTQIA+, seniors, etc.
- Knowledgeable about and experience with trauma-informed practices, mental health conditions and addictive disorders
- Ability to perform intermediate computer and data entry skills
- Ability to apply emotional and cultural intelligence to provide appropriate communication and patient care
- Ability to sufficiently engage patients in a variety of settings including phone, in person/homes, community streets/shelters, and/or healthcare settings
- Knowledgeable about the community-based resources, especially non-professional resources and their reputation in the community
- Ability to develop relationships with community patients and leaders, including faith-based community
- Ability to make decisions and sound judgements to anticipate the needs of patents and knowing when to consult with the team, supervisors, and experts
- Excellent verbal and written communication skills, including superior composition, typing and proofreading skills
- Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
- Ability to successfully manage multiple tasks simultaneously, including changing priorities and time sensitive deadlines
- Excellent planning and organizational ability
- Excellent teamwork and relationship building skills
- Ability to work as part of a team as well as independently
- Ability to work with highly confidential information in a professional and ethical manner
- Ability to lift/carry 20 lbs/weight
- Ability to stand for long periods of time
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