Community Health Team - CHW/CMA Hybrid South County

Job Title:  Community Health Worker (CHW)/ Care Management Assistant (CMA) Hybrid South County

Reports to:  Director, Integrated Care Management

Department:   Integrated Care Management

FLSA Status:  Non-Exempt

Job Grade:  6

Version Date: April 2024                                                         

General Responsibilities:

The Community Health Worker is a member of the Community Health Team (CHT); a multi-disciplinary team comprised of Nurse Care Managers, Community Health Workers, Care Management Outreach Workers, and Behavioral Health Clinicians. The CHT supports patients of Thundermist Health Center who are dealing with complex medical and behavioral health and/or substance issues and require a more intensive home and community-based intervention. Community Health Workers play a critical role in the CHT by providing care coordination, peer support, community resources and referrals. They visit patients in their homes and in the communities in which they live while providing culturally sensitive approaches to help patients achieve their health goals.

The Care Management Outreach Worker is responsible for providing administrative, clerical and patient engagement support to the Community Health Team (CHT). The Community Health Team is a team made up of Nurse Care Managers, Community Health Workers and Behavioral Health Clinicians. This is a communitybased team who supports patients at Thundermist Health Center who are dealing with complex health issues.

Qualifications:

Required Qualifications:

• High School diploma and a combination of education and skills to effectively carry out responsibilities and assignments
• Previous experience working in a community-based setting.
• Ability to work independently and effectively in a team environment
• Valid driver’s license and reliable transportation with proof of RI minimum requirements of auto insurance (including a 100/300 K Rider) to utilize your automobile for work purposes.
• Highly organized and strong interpersonal skills.
• Maintain timely and accurate records and documentation
• Demonstrated experience working with Electronic Health Records, computers and other technology and Microsoft Office applications. 
• BLS Certification

Preferred Qualifications:

• English, Spanish and Portuguese written and spoken language

• Candidates who do not meet all of the preferred qualifications are encouraged to apply.

Significant Job Functions:

• Key member of multi-disciplinary Community Health Team who collaborates with physicians, other care team members (Medical Assistants, Nurses, etc.), hospitals, partner agencies, members of the CHT in the patient’s network of care to improve patient care; Obtain progress notes from outside providers involved in patient care.
• Meet with patients in the community, at their home, in the hospital, or other community settings.
• Accompanying patients during doctor’s appointments, assisting with food access needs, picking up prescriptions at the pharmacy, completing forms for benefit applications, and assist with other tasks as needed that support their medical and behavioral health care needs. Transportation of patients may also be required if patient does not have access to any other form of transportation, or if it is a critical appointment that requires staff transport.
• Build trusting relationships, serve as an advocate, and peer mentor with the goal of empowering the patient to become more independent and self-sufficient.
• Utilize Motivational Interviewing skills and other patient engagement techniques with patients and caregivers.
• Conduct health assessments.
• Assist in the development of a patient Care Plan to include actions designed to improve the patient’s health status. Remove the barriers that are preventing them from getting high quality and timely access to PCP and specialist care.
• Educate patients on appropriate Urgent Visit and ER use.
• Provide administrative, clerical and patient engagement support to the Community Health Team

members.

• Schedule patient appointments
• Make appointment reminder calls
• Schedule transportation for patients to relevant appointments
• Identify required information in the Electronic Health Records (EHR)
• Data entry and documentation in the EHR and other files
• Ability to prioritize workflow and handle multiple demands
• Familiarity with office equipment and procedures
• Perform other duties are required.

Physical Effort/ Environment:

• This role is hybrid position, allowing duties to be performed from home or at a Thundermist site. In this role, the expectation is that CMA work can be done remotely, and CHW work requires on-site and community presence. Scheduling will be based on patient and department needs.
• Meet with patients at their home, in the hospital, or other community settings.
• Flexibility to travel within Rhode Island to meet the needs of the patient.
• General office environment: manual dexterity needed for keyboard work, writing and phone calls.
• Use of technology for home monitoring, telemedicine, and other devices, as needed.

Work Schedule Demands:

• Full-time.

Communication Skills:

• Strong communication skills, both oral and written.
• Ability to relate to patients and build trusting relationships.
• Ability to communicate effectively with co-workers, patients, family/care givers, and partner agencies.

Confidentiality of Information:

Thundermist is dedicated in securing the privacy and confidentiality of protected health information under the Health Insurance Portability and Accountability Act. It is the responsibility of all employees to comply to state and federal guidelines in accessing sensitive information. The incumbent must apply strict confidentiality.

ADA & EEOC Statement:

Thundermist is dedicated to the goal of building and maintaining a diverse and inclusive workforce committed to caring for patients in a manner that is respectful of cultural difference. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.