What are the responsibilities and job description for the Community Health Worker position at AbsoluteCARE Medical and Pharmacy?
Why Work at AbsoluteCare?
At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into members: people who are entitled to some of the best, most focused care this country has to offer.
We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make the most important services available to our members under one roof. This includes a pharmacy, X-rays, a blood lab, nutrition services, urgent care, and much more.
We don’t stop at our four walls. We engage members in the communities where we all live to find the people who need us most. Through these community care teams, we remove the barriers to healthcare that so many people face daily. And it works.
Our unique care is guided by our core values of accountability, caring, trust, and teamwork. We call it ACT2.
Job Summary
This role is a core member of the interdisciplinary care team (ICT), focused on supporting members’ compliance to their treatment plan and locating those who have been lost to care. Primarily interfaces with members in the community setting, meeting members in their home or community location. This role serves as an active support to members to encourage and educate on the importance of medical care and compliance with treatment and care plan goals. The CHW-BH is knowledgeable of community resources and acts as a liaison between members and resources to refer and link members to necessary community-based services. This role establishes and maintains a trusting rapport with members, families, and relevant stakeholders for a specific assignment or within an estimated 3-6 month timeframe, as indicated, and based on the CHW trigger list.
Duties and Responsibilities
- Manage an assigned caseload of members with the primary goal of engaging the member into care, thereby reducing preventable utilization, e.g., emergency room, hospital admissions and readmissions.
- Prioritize outreach to members based on acuity level and length of time lost to care and reasons for referral based on an established trigger list for CHW engagement.
- Outreach to members/caregivers/families in the community to locate, engage, establish trust, and assist in resolving barriers to care.
- Coordinate transportation for medical/behavioral health appointments, community resources, post discharge follow up appointments, etc., as appropriate.
- Observe the home or community setting to identify needs related to social determinants of health, community integration, family/collateral information, etc., related to members’ health status. Document all information and interactions in the clinical system.
- Develop culturally competent relationships with members to promote appropriate utilization of the health care system and AbsoluteCare services.
- Participate in the interdisciplinary care team (ICT) including case consultations, rounds, and follow up.
- Facilitate member enrollment in AbsoluteCare and community programs to support community integration, independent living, and access to integrated health care, as needed.
- Responsible for prioritizing, independently scheduling visits and following up with members, including reviewing member information prior to outreach.
- Accompany members to medical, behavioral health, and/or community resource appointments to support adherence to treatment plan, advocate for member needs, and assist in completion of applications, as appropriate.
Minimum Qualifications
- High School degree or equivalency required.
- Hold and maintain active driver’s license and proof of insurance in state of practice.
- 2 years serving the needs of the local population, preferably in a healthcare setting or community/outreach organization with experience in the following:
- Working knowledge and relationships with community resources and support services
- Cultural competence in working with a diverse population
- Delivering peer support
- Ability to work independently in the field
