Community Health Worker Senior - Family Health

Hennepin County Medical Center Minneapolis, MN
Current vacancy is Grant-funded through 2022, it is full time with benefits, 80 hours per pay period, day shift. This position requires travel, home visits, community outreach, etc. Valid Driver's License and availability of insured vehicle required.


The Community Health Worker will be responsible for assisting patients and care team members across the continuum with a variety of care coordination activities, helping patients to navigate the healthcare system, understand and connect to HCMC and community resources, eliminate barriers to care, and increase knowledge around self-management and health promotion activities.


* Provide care coordination, assistance with health system navigation, connection to community resources, elimination of barriers to care and the provision of education around self-management and health promotion activities

* Communicate and collaborate with patients, families, providers, and care team members to address patient needs and care plan

* Encourage and support patients to make concrete steps toward promoting their health and managing their chronic illnesses (e.g. diabetes, asthma, vascular diseases)

* Conduct needs assessments, health questionnaires, and screenings for patient population

* Offer appropriate suggestions and insights to providers, patients, and care team members for bridging barriers to goal achievement

* Remind patients of appointments, assist with transportation and other barriers to making appointments, and attend appointments with patients when deemed necessary

* Adhere to department expectations around caseload, panel management, and referral management

* Work within his/ her scope of work by referring patients to appropriate clinic, hospital and community resources and support them in accessing resources

* Utilize electronic health records to inform providers and care team members of patient goal progress and document all care coordination, transition care, and health education activities

* Facilitate completion and submission of forms and paperwork, as trained

* Actively coordinate services, facilitate transitions of care across the continuum, communicate with care team members and participate in interdisciplinary huddles, rounds, and/or care team meetings

* Provide patient education for health promotion, disease management, and self-management within the scope of service of the CHW and only when trained and delegated to do so

* Motivate clients and/or family to be active, engaged participants in their health, education and self-sufficiency goals

* Coordinate, facilitate, and implement health promotion and self-management programs when directed

* Perform field visits at home and community sites, only if required and approved by your department

* Meet care coordination requirements as outlined by the Minnesota Department of Health or the Department of Human Services if working in a clinic that is seeking or has achieved Health Care Home or Behavioral Health Home certification

* Complete other duties as assigned (including grant-related activities), but only when trained and qualified to do so


Minimum Qualifications:

* Completion of the Community Health Worker certificate program through an approved college or technical school in Minnesota. Employees must have this completed within 18 months of hire to maintain employment

* AND-

* Unique Minnesota Provider Identifier (UMPI) will be acquired through the onboarding process, if not already acquired

* AND-

* Driver's license and proof of insurance, if field visits are required by your department

Preferred Qualifications:

* One year of experience working in any of the following: ambulatory care, care coordination, case management, or community outreach

* Working knowledge of various integrated systems of care in the community

Knowledge/ Skills/ Abilities:

* Knowledge of care coordination and how to help patients navigate the healthcare system

* Understands the CHW scope of practice in MN and role within the health system

* Ability to speak and write the English language in an understandable manner

* Strong communication skills, both verbal and written

* Strong skills in providing disease prevention/ health promotion programs to patients with chronic conditions

* Excellent organizational, communication, customer service, and computer skills

* Ability to provide guidance to people with a wide range of cultural backgrounds, training, and experience

* Conflict resolution and interpersonal communication skills

* Strong problem solving, trouble shooting and decision making skills

* Ability to work independently and as part of a team

* Flexible and willing to adapt to a changing healthcare environment

* Ability to set and maintain boundaries to work within role and scope of practice

* Ability to work in an environment with multiple distractions and interactions