Community Health Worker

Role Description

The purpose of a Community Health Worker (CHW) at Oak Street Health is to act as the bridge between our patients, community, and medical systems in order to remove barriers and increase wellness across all life domains. A CHW is a patient’s advocate or liaison, accompanying patients through proactive in-person and phone outreach based on their care needs to promote health literacy and increase access to resources needed to live healthier lives. High levels of flexibility, problem solving, strong communication, and an intimate knowledge of the community served are required to be successful. CHWs work closely with MSWs to manage patient care plans, support care team decision making, and coordinate clinical and complementary services needed to provide high quality health care and improve the quality and cultural competence of service delivery. CHWs are expected to work within their scope of practice. There is no expected clinical license for this position.

Check out this for a sneak peek into the life of an Oak Street CHW!

Core Responsibilities Include :

Establish and maintain strong interpersonal relationships with patients, community organizations, team members, and partners to coordinate patient needs

Manage patient referrals defined by the care team & collaborate with the Medical Social Worker on action plan

Facilitate communication between all identified parties involved in patients’ care as needed (e.g., family members, caregivers, medical providers, community-based organizations)

Form relationships with and build an inventory of local community organizations that may benefit our patients

Connect patients to state and local community resources related to housing, transportation, food, and activities of daily living among other social and physical barriers to health.

Assist patients with completion of applications for accessing eligible benefits and resources

Promote goal setting and achievement to improve patients’ quality of life and self efficacy with patients. Goal definitions are agreed upon by the care team

Meet with patients in patient-centered and patient-preferred locations (e.g., Oak Street Health center, patient’s home, external medical provider facility, community setting)

Community Health Workers should plan to spend about half of their time outside of the center in patient-centered locations; this means having access to a reliable means of transportation to do so is required

Drive engagement with high risk individuals (e.g., completed specialty appointments, adherence to Post Discharge Visits) may include accompaniment to appointments

Complete referrals to organizations and agencies as needed

Deliver culturally appropriate health education in the areas where OSH has provided competency training to the CHW

Support care team decision making through participation in interdisciplinary team meetings

Document interactions with patients in electronic medical record in a timely manner while maintaining HIPAA standards and confidentiality of protected health information

Manage time, set priorities, work independently, and collaborate effectively with an interdisciplinary medical team

Other duties as assigned

What we’re looking for

We’re looking for motivated individuals with :

Required

Minimum of 1 year of experience in healthcare, community-based, case management, or social service environment

Strong oral and written communication skills

Ability to manage multiple priorities while maintaining a positive attitude

Dedication to serving the community and building meaningful relationships

Proficient computer skills (i.e. Windows, GSuite, Microsoft, etc.)

Access to reliable transportation and ability to travel throughout the community to various locations

US work authorization

Strongly Preferred

Fluency in language that is commonly spoken in the community when necessary. Most often this will include Bilingual English / Spanish

Experience working on multidisciplinary teams with organizations, agencies, patients, and community members

Knowledge of community resources and resource navigation

Preferred

Community Health Worker certification or Associates or Bachelors in a related field is a plus

Experience utilizing electronic medical record systems

Other Skills

A problem-solving orientation and a flexible and positive attitude

Someone who embodies being “Oaky”