Community Health Worker

Role Overview

• Provide care coordination and resource navigation to an assigned caseload of community member clients with unmet social needs.
• Conduct consistent telephonic and face-to-face outreach, follow-up, and coaching to members to assess needs, provide education, and assist with enrollment in eligible services/benefits/programs.
• Administer social determinants of health (SDOH) screening, intake forms, and any needed assessments in the Activate Care platform.
• Assist clients with prioritizing goals and creating client-centered care plans.
• Coordinate with community nonprofits and resources to help clients meet their needs.
• Provide resources to clients to improve their health literacy and self-sufficiency.
• Coordinate healthcare transitions by leading outreach and follow-up for members post-hospital discharge or ER visits and collaborating with providers and families to ensure continuity of care and prevent readmissions.
• Navigate complex care environments by coordinating member care across multiple healthcare settings while facilitating referrals to specialty or behavioral programs as needed.
• Support Medicaid and health plan navigation by partnering with health plan teams to support service authorizations, help members understand their benefits/appeals, and advocate for their care coordination needs.
• Engage vulnerable populations by providing person-centered coordination for high-risk members experiencing housing instability, complex medical conditions, or other acute social barriers to care.
• Take a proactive approach to assist with assigned cases (e.g. help schedule appointments, complete applications, make reminder calls, etc.)
• Maintain client privacy and uphold confidentiality at all times.
• Participate in weekly team meetings, workshops, and training to expand knowledge of department priorities, while remaining current on new developments, as required.
• Ability to commute to and from client’s homes and field locations as required.
• Other duties as assigned.

Requirements

• Degree requirements: Candidates should possess a minimum of a high school diploma or equivalent.
• Must have a valid driver's license in the state of Nevada.
• Must be able to use personal vehicle to commute to and from clients' homes.
• 2-3 years of relevant work experience providing direct care coordination services to individuals and families (preferred).
• Experience working directly with nonprofits, social service providers, faith-based groups, or government agencies that address social determinants of health.
• Exceptionally strong independent working skills with strong communication.
• A collaborative team player who is committed to supporting, encouraging, and helping their team of colleagues.
• Cultural humility: You are able to communicate effectively with people from various backgrounds and work respectfully across demographic, socioeconomic, language, and all other constituents that represent diverse cultures of communities.
• Additional language skills are a plus!