Community Health Advocate

• Establish rapport with patient and caregivers, evaluate patient’s level of health literacy and comprehension, provide information/guidance for an effective care transition and follow up
• Build and maintain a positive working relationship with providers, community-based organizations, social services, and public health
• Monitor effectiveness of services provided by external resources and provide timely feedback to the provider/interdisciplinary team
• Act as liaison with members and families to physicians, staff, community resources
• Act as the liaison between the healthcare team and community resources
• Advocate for the patient and family by locating appropriate community resources to address concerns and reduce risk of hospitalization or readmission
• Coach patient/caregiver to improve their communication with physicians, nurses, and other members of the healthcare system
• assist patient/caregiver in setting, tracking and meeting personal health goals
• Collaborate on patient care issues with an interdisciplinary team
• Facilitate patient self-management skills around health status and problem solving for barriers to care
• Meet and/or follow-up with patients via phone and/or clinic visit to coordinate and/or provide timely direct assistance
• Monitor patient progress towards achievement of goals identified in the plan of care and provide ongoing status reports to the healthcare team
• Model commitment to continuous quality improvement
• Assist with administration of social determinants of health screening activities as assigned
• Ensure documentation is accurate, useful and in compliance with company policy
• Review, interpret, and escalate to care team data and/or information from multiple different electronic platforms
• Data entry, scheduling appointments and other related tasks
• Assist patients / caregivers with completion of various forms and paperwork related to identified social need(s)

• High School Diploma/G.E.D.
• 1 year experience in a patient-care environment
• or 2 years working in a health-related community outreach organization.
• Preferred: AA or BA.
• Preferred: Knowledge and ability to work with electronic medical records
• knowledge of healthcare terminology.
• Preferred: CHW Certification

• AA or BA
• Knowledge and ability to work with electronic medical records
• knowledge of healthcare terminology
• CHW Certification

medical, prescription drug, dental, vision plans, life insurance, paid time off, tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings