About The Position
This role is part of a new company we are actively incubating in the US care navigation space. This is a chance to be on the ground floor of something being built from scratch. As a Community Health Worker, you'll work directly with patients to identify and remove the upstream barriers—housing instability, food insecurity, transportation gaps, utility shutoffs—that are keeping them from getting the care they need. You're the person who solves the problems. You connect patients to resources, teach them how to navigate systems, advocate on their behalf, and follow through until the barrier is gone. You'll work under the general supervision of a billing practitioner, and your work will be reimbursed through Medicare's Community Health Integration (CHI) codes (G0019/G0022). Meaning: this isn't volunteer work or grant-funded, this is a sustainable, reimbursable model that pays for exactly the kind of support patients desperately need.
Requirements
- CHW certification or equivalent training (state-recognized programs preferred)
- 3+ years of experience in community health, social work, case management, or patient navigation
- Exposure to Medicare/Medicaid billing or managed care environments
- Working knowledge of SDOH domains: housing, food, transportation, utilities, social isolation
- Comfort with time-based documentation and structured note-taking
- Strong interpersonal skills — you build trust with patients in their hardest moments
Nice To Haves
- Bilingual candidates strongly encouraged to apply
Responsibilities
- Build trusting, person-centered relationships with patients facing complex social and health challenges
- Conduct person-centered SDOH assessments, set goals, and build action plans tied to each patient's treatment plan
- Connect patients to housing authorities, SNAP/food pantries, NEMT providers, utility assistance programs, and community-based organizations (CBOs)
- Facilitate access to care – scheduling, referrals, appointment navigation, and follow-through
- Coach patients on self-advocacy and navigating both clinical and community systems
- Document all activities with precision: time logs, activity descriptions, Z-codes (Z55–Z65), and linkage to the clinical care plan
- Coordinate across the care team (billing practitioner, specialists, CBOs, social services) to ensure closed-loop referrals
- Maintain monthly encounter notes that pass audit – referral made, referral received, barrier reduced
Benefits
- Direct patient impact, backed by structured clinical oversight
- Help build a company from the ground up – shape how we operate, and deliver care from day one
- Competitive compensation + benefits
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
