Care Transitions Community Health Worker

Community Health Center Network Inc • San Leandro, CA

4h • $26 - $32 • Onsite

About The Position

The Community Health Worker (CHW) will provide in-person support to Community Health Center Network (CHCN) members who present at Sutter Health System hospitals, focusing on improving health outcomes by connecting patients to their primary care providers and reducing unnecessary acute care utilization. This role acts as a vital liaison between Sutter Health care teams and CHCN health centers, ensuring seamless care coordination for patients.

Requirements

• Strong Communication Skills: Must possess excellent verbal and interpersonal communication skills to build positive relationships with hospital staff and community health teams. The CHW will represent CHCN within the hospital setting and must be an effective liaison.
• In-Person Role: This position requires regular in-person presence at the Sutter Health System hospital Emergency Department (ED), and the CHW must have reliable transportation to and from the assigned hospital site.

Nice To Haves

• Ability to work collaboratively in a fast-paced, dynamic environment.
• Compassionate and patient-centered approach to care coordination.
• Strong organizational and time management skills.

Responsibilities

• ED Case Management Collaboration: Work closely with Emergency Department (ED) case management teams to review CHCN patients and determine whether outpatient care would be a more appropriate option for their needs, aiming to reduce unnecessary ED visits.
• Follow-Up Scheduling: Engage with CHCN patients in the ED, assess their care needs, and schedule follow-up appointments with their primary care providers to ensure continuity of care.
• Medication and Referral Coordination: Facilitate communication with CHCN providers to address any medication refills or non-urgent referrals, ensuring patients do not need to return to the ED for these services.
• Hospital Discharge Support: Assist high-risk CHCN patients who are hospitalized at Sutter hospitals, ensuring they are scheduled for follow-up with the Advanced Care Transitions (ACT) Team to support their post-discharge care.
• Care Handoff: Collaborate with inpatient care teams to transfer key information about high-risk patients to ACT providers, ensuring a smooth transition from hospital care to ongoing management in the community health setting.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed
• Number of Employees: 11-50 employees