Job Description

The purpose of a Community Health Worker (CHW) at Oak Street Health is to act as the bridge between our patients, community, and medical systems in order to remove barriers and increase wellness across all life domains. A CHW is a patient's advocate or liaison, accompanying patients through proactive in-person and phone outreach based on their care needs to promote health literacy and increase access to resources needed to live healthier lives. High levels of flexibility, problem solving, strong communication, and intimate knowledge of the community served are required to be successful. CHWs work closely with MSWs to manage patient care plans, support care team decision making, and coordinate clinical and complementary services needed to provide high quality health care and improve the quality and cultural competence of service delivery. CHWs are expected to work within their scope of practice. There is no expected clinical license for this position. Core Responsibilities include establishing and maintaining strong interpersonal relationships with patients, community organizations, team members, and partners to coordinate patient needs; managing patient referrals defined by the care team and collaborating with the Medical Social Worker on action plans; facilitating communication between all identified parties involved in patients care; forming relationships with and building an inventory of local community organizations; connecting patients to state and local community resources related to housing, transportation, food, and activities of daily living; assisting patients with completion of applications for accessing eligible benefits and resources; promoting goal setting and achievement to improve patients quality of life and self-efficacy; meeting with patients in patient-centered and patient-preferred locations; spending about half of their time outside of the center in patient-centered locations requiring reliable transportation; driving engagement with high-risk individuals; completing referrals to organizations and agencies; delivering culturally appropriate health education; supporting care team decision making through participation in interdisciplinary team meetings; documenting interactions with patients in electronic medical records while maintaining HIPAA standards; managing time, setting priorities, working independently, and collaborating effectively with an interdisciplinary medical team; and other duties as assigned.

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