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Care Management Community Health Worker
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Full-time
- SUMMARY: Provides care coordination and advocacy to patients, including outreach and engagement, development of the care plan, linkage of the patient with resources (food, housing, transport, financial, community based services) as well as linking the patient with care.
- Administers risk assessment or intake interviews with patients and/or families and records this assessment in the patient's medical record; assesses patient's level of functioning, environment, appropriateness and adequacy of support system related to illness and ability to cope.
- Screens for any barriers to care such as substance abuse, neglect or housing.
- Serves a resource and provides counseling and treatment related to Substance Abuse or palliative care or end of life planning.
- Coordinates any appropriate documentation (consents, assessment tools) to the staff or EHR.
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