ECM COMMUNITY HEALTH WORKER

Description

JOB SUMMARY

The Enhanced Care Management (ECM) Community Health Worker (CHW) plays a vital role in supporting patients with complex medical, behavioral health, and social needs. The CHW serves as a trusted member of the care team, providing outreach, engagement, and navigation support to help patients access healthcare and community resources. The CHW works closely with case managers, providers, and community partners to reduce barriers, improve health outcomes, and empower patients to actively participate in their care.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Conduct outreach to patients eligible for ECM services through phone calls, home visits, and community-based engagement.
• Build trusting relationships with patients, their families, and caregivers to support care plan goals.
• Assist patients in navigating healthcare systems, including scheduling appointments, transportation coordination, and accessing primary/behavioral health services.
• Identify and connect patients to community resources, including housing, food, financial assistance, and social support services.
• Support care managers by reinforcing care plans, helping patients follow through on goals, and addressing day-to-day challenges.
• Provide culturally appropriate health education and encourage self-advocacy in care decisions.
• Document outreach activities, resource connections, and patient progress in the electronic health record (EHR) and program tracking tools.
• Participate in interdisciplinary case conferences and care team meetings.
• Advocate for patients by helping them overcome barriers to care and promoting equitable access to services.
• Maintain confidentiality and comply with HIPAA and organizational policies.

Requirements

EDUCATION, TRAINING AND EXPERIENCE

• Associates or Bachelor’s degree preferred.
• CHW/P/R Certification preferred; not required
• 1+ years working in related field preferred.
• Knowledge of determinants of health, health behavior and outreach strategies
• High school diploma or GED required; Associate’s or Bachelor’s degree in Public Health, Social Work, Human Services, or related field preferred.
• Minimum 1–2 years of experience in community outreach, patient navigation, health education, or related field (lived experience in the community served strongly valued).

KNOWLEDGE, SKILLS AND ABILITIES

• Strong understanding of social determinants of health and the barriers faced by underserved communities.
• Ability to build rapport, trust, and supportive relationships with patients from diverse cultural and socioeconomic backgrounds.
• Skilled in communication, active listening, problem-solving, and conflict resolution.
• Familiarity with local community resources, public assistance programs, and social service systems.
• Ability to work independently and collaboratively as part of an interdisciplinary team.
• Strong organizational skills, with the ability to manage multiple patients and tasks.
• Comfort with documentation, data entry, and use of electronic health records or case management systems.
• Commitment to cultural humility, trauma-informed care, and patient-centered engagement.
• Ability to find solutions when barriers are identified.
• Strong documentation skills.
• Ability to multi-task and prioritize when needed.
• Ability to independently seek out resources and work collaboratively.
• Ability to read, understand, and follow oral and written instructions.
• Experience and work ethics that support working within a high-functioning, team-oriented environment.
• Demonstrates a willingness and ability to work under supervision.
• Ability to develop and maintain good working relationships with staff.
• Ability to use computers and learn new software programs.
• Excellent interpersonal skills reflecting clarity and diplomacy and the ability to communicate accurately and effectively with all levels of staff and management.
• Demonstrates ability to work in a regulatory climate that includes oversight of state and federal entities, payer contracts etc.
• Possesses the ability to communicate effectively, both verbally and in writing.
• Possesses genuine respect for others and acceptance of their individual social and cultural traits.
• Proficient knowledge of Microsoft Outlook.
• Able to travel and attend professional meetings, conferences, training, and clinic sites.
• Demonstrate flexibility, enthusiasm, and willingness to cooperate while working with others in multi-disciplinary teams.
• Performs other related duties as assigned.

PHYSICAL DEMANDS

Position requires prolonged sitting at a computer, some bending, lifting, stooping and stretching. Good eye-hand coordination and manual dexterity sufficient to operate a computer keyboard, photocopy machine, telephone, and other office equipment is also required. Employee must have normal range of hearing and eyesight.

NOTE: The essential job functions for this position include, but may not be limited to those listed in this job description. Employees hired for this position must be able to perform the essential functions of this job without imposing significant risk of substantial harm to the health or safety of themselves or others