Community Hlth Outreach Worker - Washington, United States - MEDSTAR HEALTH

Description

Works closely with community health, case management care teams, and social services agencies to provide short term care coordination and connection to resources and programs for members to improve their health and general well-being through education and provision of coordination of care and services. Works in community-based settings, including patient's homes. Serves as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. Builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support, navigation support and advocacy. Completes community outreach, such as home visits, assessments, care coordination and health screenings.

We recruit, retain, and advance associates with diverse backgrounds, skills, and talents equitably at all levels.
Education

High School Diploma or GED Required or

equivalent. Required and

Residency within the target population Preferred and

Successful completion of a Community Health Training program Preferred

Experience

Prior work experience not required Participation with a community organization Preferred

Knowledge, Skills, and Abilities

Effective oral and written communication skills.

Personal knowledge of the target population, as shown by residency in that neighborhood.

Cultural competency. Knowledge of local resources and system navigation.

Advocacy and community capacity building skills.

Care coordination skills.

Teaching skills to promote healthy behavior change.

Outreach methods and strategies.

Ability to bridge needs and identify resources.

Understanding of ethics and confidentiality issues.

Ability to use and understand health information technology.

Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.

Advocates for individual and community health equity.

Assists members in accessing health related services, including but not limited to: obtaining a medical home, dental home, linkage to behavioral health resources. Provides instruction on appropriate access of services, overcoming barriers to obtaining needed medical care and /or social services. Accompanies members to appointments as needed to enhance compliance when necessary. Examples include but are not limited to: medical, dental, social services, community resources.

Assists members in their homes, community, or clinic setting. Communicates to members the purposes of the program and the impact it may have on their wellbeing. Helps members identify socio-economic issues that affect their overall health and develop health/social management plans and goals.

Assists to locate members in the community and link to Case Managers or Wellness Coordinators at the Health Plan.

Assists with the completion of health risk assessments. Examples include but are not limited to: Health Risk Assessments, Assessments of Social Determinants of Health.

Collects, tracks and reports information about the community and community benefits.

Documents all patient encounters; completes and submits monthly reports; maintains comprehensive electronic client files, which include client notes, release of information, assessments and other medical documents acquired on behalf of the patient. Documents activities, service plans, and outcomes achieved by patient in an effective manner.

Educates members on the proper use of the Emergency department/Health system services and provides information for alternatives.

Coaches members in effective management of their chronic health conditions and self-care. Assists members in understanding care plans and instructions. Motivates members to be active and engaged participants in their health and overall wellbeing.

Enhances community residents' ability to effectively communicate with health care providers. Identifies and addresses issues that create barriers to care for specific individuals.

Integrates with members care team to support progress in care plan and overall patient wellness and preventative care services.

Proactively identifies and refers individuals to federal, state, private or nonprofit health and human services programs. Educates members on community and health plan benefits.

Provides care, support, follow up, and education in community settings. Provides culturally and linguistically appropriate health education.

Provides evidence-based health guidance and social assistance to community residents.

Provides referral and follow-up services or otherwise coordinates human services options.

Serves as a liaison between communities, individuals and coordinated health care organizations. Staffs community events and activities as needed.

Participates in multi-disciplinary quality and service improvement teams.

Performs other duties as assigned.