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Community Health Worker, High Risk Intervention, 40 hours

Job ID 147811 Date posted 05/10/2018

Position Summary:

Funded under a grant from the Health Policy Commission, the Community Health Worker (CHW) position was created to reduce ED utilization by connecting socially complex and behavioral health patients to services.

Working under a licensed social worker, the (CHW) will work directly with patients, families and caregivers. The (CHW) will work with at-risk patients and families in all settings including homes to assess their ability to care for themselves. They will assist patients in connecting with any and all available resources with the goal of improving the patient?s quality of life and avoiding unnecessary hospitalizations.

Essential Duties:

As part of the Chart II Behavioral Health team, this position:
1. Establishes and maintains a supportive relationship with assigned patients, to include the following:
Engages patient who meet high\moderate utilizer population eligibility via multiple modalities (face to face>telephonic>email) at a frequency determined by patient need
Provides non-judgmental listening and, where applicable, motivational interviewing

2. Provides case management services to include:
Ensures care coordination amongst all providers
Linkages to peer networks/natural supports when able/appropriate
Facilitates and coordinate referral to community social service providers as requested by clinician or care provider
Ensures follow up on referrals
Assists clients in accessing further treatment, self-help groups, housing and services related to physical \behavioral health and other activities of daily living
Provides for or helps the client and his/her family or natural supports with psycho-education and provides educational materials on mental health and substance use disorders and treatment.
Manages CHART Tasks by patient and updates care manager tool
Addresses housing needs (makes an effort to explore and partner with local housing authority for temp and permanent housing)
Helps arrange transportation for patient when necessary

3. Helps implement patient?s treatment plan
Provides input to social worker in constructing and when needed revising treatment plan
Follows treatment plan duties assigned to Community Health Worker
Organizes and communicates patient?s outpatient treatment schedule, including medical and behavioral health
Identifies and addresses obstacles to patient compliance with outpatient treatment

4. Facilitates alternatives to Emergency Department visits
Maintains awareness of patient?s level of functioning and symptoms and reports status to clinician
Facilitates patients being assessed by ongoing outpatient provider or Emergency Psychiatric Services in non-hospital setting, if the patient?s functioning is deteriorating or symptoms are increasing


Knowledge, Skills & Abilities:

Strong networks with Essex County community resources and the ability to create new relationships
Ability to work collaboratively within a multi-disciplinary team unit
High energy and a sense of humor
Ability to overcome obstacles in a positive, productive manner; problem solving skills are critical
For safety and quality reasons, must be able to read, write and communicate effectively in English with patients, visitors and fellow members of the hospital team.

Required Education/Experience:

BA/ BS in psychology, counseling or social work
Preferred: 1-2 years in direct patient care within a Behavioral Health/Substance Abuse setting
Preferred: Hospital Experience Preferred
Willingness and ability to perform outreach services
Must have knowledge of medical and medication terminology
Working knowledge of health care plans and benefits
Familiarity with PC?s and MS Office software applications
EPIC experience preferred

Scheduled Hours

40 hours per week, 8 hour day shifts, M-F