The Community Health Worker (CHW) will be an integral member of an interdisciplinary health home care management team. The CHW will work closely with health home patients, care managers, other care management team members, health care providers, social services providers, and community partners to effectively manage the care of designated health home patients.
The Community CAre Transitions (C-CAT) Initiative is seeking an experienced Community Health Worker to join our team. The C-CAT Initiative prioritizes best practice by focusing on patient-centered care, incorporating patient perspectives, and addressing unmet needs and social determinants of health (SDOH) through telephone calls, emails, texts, video visits, home visits (post COVID-19) and collaboration with the patient's care team. By creating space for patients to voice their concerns about their clinical care and what they perceive to be the biggest barriers to staying well outside the hospital, our CHWs bring greater awareness to all members of the interdisciplinary care team, foster patient connections to care teams, and work actively to connect patients to low and no-cost services to close resource and knowledge gaps contributing to sub-optimal care.
The C-CAT Community Health Worker (CHW) will be an integral member of an interdisciplinary home health care management team. The CHW will establish a partnership with patients and work closely with patients' care managers, other care management team members, health care providers, social services providers, and community partners to effectively manage the care of patients during a thirty to forty-five day CHW/patient partnership following hospital discharge.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
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