Case Manager, Older Adults and Adults with Disabilities

East Bay Community Action Program
Full-time, $21-$30 hours
Associate’s Degree or Experience

East Bay Community Action Program (EBCAP) is seeking a compassionate and organized Case Manager to support older adults and adults with disabilities across Rhode Island. This role is ideal for someone who is passionate about person-centered care, enjoys working in the community, and thrives in a collaborative, mission-driven environment.

As a Case Manager, you’ll provide unbiased care coordination and case management services to individuals enrolled in Medicaid, Cost Share (CNOM), and Adult Protective Services (APS). You’ll work closely with participants, families, service providers, and internal teams to promote safety, independence, and overall well-being.

Position Details

  • Status: Full-time (30–40 hours/week)
  • Pay Range: $21–$30/hour (based on experience)
  • Work Environment: Hybrid (remote up to 2 days/week; community-based visits required)

Key Responsibilities

What You’ll Do

  • Conduct assessments to understand participants’ strengths, needs, resources, and goals
  • Develop and maintain person-centered care plans
  • Coordinate services for older adults, adults with disabilities, and individuals with I/DD
  • Meet with participants in homes, assisted living facilities, group homes, and community settings
  • Partner with home care agencies, adult day health providers, and other community supports
  • Monitor progress and update care plans as needs change
  • Respond to Adult Protective Services (APS) referrals and help ensure participant safety
  • Maintain timely and accurate documentation in electronic case management systems
  • Communicate regularly with participants, families, and interdisciplinary team members

Qualifications

What We’re Looking For

  • Compassionate, client-centered approach to service delivery
  • Strong communication, organization, and time-management skills
  • Ability to manage shifting priorities and work independently in the community
  • Comfortable collaborating with diverse teams and service providers
  • Commitment to confidentiality, cultural competence, and ethical practice

Minimum Requirements

  • Associate’s degree (or equivalent combination of education and experience)
  • Minimum of two years of case management experience
  • Valid driver’s license, reliable transportation, and auto insurance
  • Willingness to travel statewide within Rhode Island

Preferred

  • Bachelor’s degree in Human Services, Social Work, Nursing, Psychology, Gerontology, or related field
  • Experience working with older adults or adults with disabilities
  • Bilingual in Spanish and/or Portuguese

Benefits

  • Heavily subsidized medical through BCBSRI
  • Dental and Vision Insurance through Dental Dental
  • Generous 403(b) retirement plan with up to 3% company match
  • Substantial paid time off including vacation, 12 holidays, personal days, and sick time
  • Tuition reimbursement and paid CEU opportunities
  • Supportive team environment focused on collaboration and excellence

Ready to Make a Difference?

We welcome candidates from all backgrounds who are passionate about making a positive impact in our community. Join us in our mission to provide exceptional behavioral health services and support to those who need it most.

Apply today and become part of a team that truly cares!

Bilingual Newport School Liaison, Children with Special Needs

RIPIN
Full-time, $21-23/hr
Bilingual Spanish Required
Knowledge of special health care and education systems in RI required

About RIPIN:

RIPIN deploys a peer model to support people with special healthcare and education needs across the whole lifespan. Founded in 1991 by a group of parents of children with special needs, RIPIN continues to be peer-led: a majority of our board and more than three-fourths of our staff are parents or caretakers of loved ones with special needs. RIPIN’s peer professionals now help more than 45,000 Rhode Islanders every year navigate healthcare, schools, and other support systems.

Job Summary: Bilingual Community Health Worker(CHW) provides peer-to-peer support to families and children with special health care needs; completes family assessments; works with family to determine family goals and implement plan for achieving goals; links families to an array of supports and resources; provides input regarding services and programs in RI and works to mitigate system barriers to accessing services. This CHW works in collaboration with the Newport Public Schools and surrounding communities, increasing family/school partnerships, and creating awareness of parental/caregiver rights in the educational success for at-risk and students with disabilities.

Essential Functions:

  • Provide Care Coordination of services and supports, while educating parents and primary caregivers in the navigation of systems of care for their CSHCN, by promoting person-centered care and medical home model
  • Outreach to referred families within agency guidelines
  • Conduct a Family Needs Assessment for referred families and develop an individualized Family Care Plan as appropriate
  • Identify family strengths, concerns and natural supports; utilize motivational interviewing skills and culturally sensitive methods to support members in achieving their goals
  • Support each family in finding geographically convenient supports and services; Collaborate with other service providers, helping families make necessary connections
  • Mentor families encountering special education concerns, assisting families with navigating the education/special education system
  • Assist families as they transition to independence /case closure; provide follow up support as needed
  • Assist in statewide system analysis, planning and coordination with state agencies, state and local boards, community-based organizations, and community rehabilitation programs
  • Actively participate as effective team member in assigned agency meetings and team meetings. Make constructive use of individual and peer supervision/one-on- one meetings
  • Accept other duties and responsibilities as assigned

Qualifications

Knowledge, Skills, and Abilities:

  • Excellent written and oral communication skills
  • Excellent organizational skills to manage multiple priorities and tasks
  • Ability to provide peer perspective as an individual or family member of an individual with a disability, chronic condition, and/or special health care need
  • Advanced knowledge of special health care and education systems in RI and other human service systems supporting families of children with disabilities and/or special health care needs
  • Problem-solving skills to facilitate empowering experiences and positive outcomes with families
  • High level of interpersonal skills and excellent communication skills to interact on a professional level with our diverse stakeholders, including parents and professionals
  • Ability to convey complex information in a clear and understandable manner
  • Excellent organizational skills to manage multiple priorities and tasks
  • Ability to effectively work independently and in collaboration with multiple staff and programs
  • Proficiency in computer and internet navigation (online documents, search engine, government websites), as well as computer skills to maintain and update program related materials, reports and database
  • Ability to effectively carryout the mission and philosophy of RIPIN and a willingness to work cooperatively and collaboratively with multiple constituents
  • Ability to present to small and large audiences that include consumers, stakeholders, and professionals on RIPIN programs’ operations, mission, and focus
  • A deep understanding of, commitment to, and ability to carry out the mission, vision, philosophy, and values of RIPIN
  • Demonstrated proficiency with Microsoft Office/computer skills to enter data, prepare reports and correspondence

Education and Experience:

  • High school diploma/GED required; Associates Degree or Bachelor’s Degree in Human Services, Education, Health or related field strongly preferred
  • Experience supporting families and individuals with special health care and/or educational needs required
  • Demonstrated life experience as a consumer, parent or family member of a consumer with special health care and/or special education needs
  • Demonstrated knowledge of RIPIN’s programs, mission and vision
  • Experience working with and outreaching to diverse populations
  • Community Health Workers certification preferred; non-certified incumbents are expected to earn certification within 18 months of hire date
  • Fluency (speaking, reading, and writing) in English and Spanish required

Bilingual Early Intervention Parent Consultant

RIPIN
Full-time, $20-22/hr
Bilingual Spanish Required
Parenting Experience with EIP Required

Bilingual Early Intervention Parent Consultant

Salary Range: $20-$22/hour

About RIPIN:

RIPIN deploys a peer model to support people with special healthcare and education needs across the whole lifespan. Founded in 1991 by a group of parents of children with special needs, RIPIN continues to be peer-led: a majority of our board and more than three-fourths of our staff are parents or caretakers of loved ones with special needs.  RIPIN’s peer professionals now help more than 45,000 Rhode Islanders every year navigate healthcare, schools, and other support systems.

Job Summary: 
The Bilingual RIPIN Early Intervention Parent Consultant Program is funded through the Executive Offices of Health and Human Services, the lead agency for Rhode Island’s Early Intervention system. RIPIN oversees the hiring, training and placement of a parent consultant in each of the Early Intervention Programs, located throughout the state. The primary purpose is to provide the Early Intervention system with an authentic parent voice and to support, educate and inform families whose children are enrolled in an Early Intervention Program (EIP).

Essential Functions:

  • Fluency (speaking, reading, writing) in English and Spanish required to help the Early Intervention Program (EIP) by using the skills you’ve gained as a parent or primary caregiver of a child who has been in an EIP
  • To act as a resource to families and Early Intervention Providers    
  • To help families by providing support, education, accessing community resources and facilitating both in-person and virtual workshops and support groups
  • To empower families with information and support as they transition from the EIP
  • To help families get more involved with the EIP and understand their important role
  • To represent the families in EI and their voice/perspective at various meetings
  • Attend RIPIN, program, and other meetings as assigned.
  • To actively engage with families to participate in the yearly Family Outcomes Survey
  • Complete and submit all required paperwork accurately and in a timely manner
  • Promote RIPIN programs in Rhode Island
  • Accept other duties and responsibilities as assigned

Qualifications

Knowledge, Skills, and Abilities:

  • Parent or family member of a child recently involved in an Early Intervention Program
  • Strong communication skills to speak to groups, including staff, providers, and parents
  • Ability to work both independently and in collaboration with others
  • Knowledge of Early Intervention services and the Transition Process
  • Ability to work with a broad cross-section of Rhode Island parents and professionals in community and office settings
  • Ability to cooperatively work on a team
  • Ability to work a flexible schedule to meet the needs of RIPIN and the community

Bilingual Consumer Resource Specialist

RIPIN
Full-time, $20-$22/hr
Experience working with diverse populations required

About RIPIN:

RIPIN deploys a peer model to support people with special healthcare and education needs across the whole lifespan. Founded in 1991 by a group of parents of children with special needs, RIPIN continues to be peer-led: a majority of our board and more than three-fourths of our staff are parents or caretakers of loved ones with special needs.  RIPIN’s peer professionals now help more than 45,000 Rhode Islanders every year navigate healthcare, schools, and other support systems.

Job Summary:

The Consumer Resource Specialist will provide comprehensive phone and in-person supports to families and individuals navigating state/federal health insurance regulations. The Consumer Resource Specialist will ensure families and individuals are supported in a responsive and timely manner with a primary focus of providing consumers and their families with information, resources, guidance, and assistance using a peer-to-peer support model.

Essential Functions:

  • Provide daily telephone support to families, community members, and consumers regarding health insurance matters, offering information, resources, support, and problem-solving to assist families in working together with private and public entities. Provide wraparound case management and advocacy to consumers with complex needs
  • Assist consumers in understanding and accessing informal and formal dispute resolution options and procedural safeguards in health and education. Document any grievances: assist in the coordination and submission of grievances as required by funding sources and/or other public and private agencies. Refer consumers to other services or public or private agencies for additional supports as needed
  • Collaborate with RIPIN staff to continuously develop, assess, and implement outreach plan for call center programs to ensure seamless service delivery and to avoid duplication of services. Continuously develop, assess, and implement program awareness campaign to generate consumer utilization of call center resources
  • Accept other duties and responsibilities as assigned

Qualifications

Knowledge, Skills and Abilities:

  • Advanced knowledge of health insurance systems in RI and other human service systems supporting individuals with disabilities and/or special healthcare needs.
  • High level of interpersonal skills and excellent communication skills to interact on a professional level with our diverse stakeholders, including parents and professionals
  • Ability to convey complex information in a clear and understandable manner
  • Fluency (speaking, reading, and writing) in English and Spanish required

Education and Experience:

  • High school diploma/GED required, Associates Degree or bachelor’s degree in Human Services, Education, or related field strongly preferred
  • Personal experience navigating social, healthcare, and/or education systems and services for self or family member highly desired
  • Experience working with and outreaching to diverse populations
  • Experience organizing and/or delivering outreach/public awareness campaigns, workshops, and community information sessions

Physical Demands:

  • Regularly required to talk or hear
  • Regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms
  • Regularly required to climb stairs, reach, stretch, stand and bend
  • Required to have the ability to lift and/or moves up to 25 pounds
  • Required to remain at their station for prolonged periods of time

Working Conditions/ Work Environment:

  • Primary work location is a climate-controlled indoor office environment; however, may also be required to conduct visits in private homes, climbing up to three flights of stairs, and community locations
  • Flexibility for travel related to job requirements
  • Willingness and ability to work evenings and weekends as needed
  • Provide own reliable transportation with proof of valid driver’s license and RI requirements of auto insurance

Youth Justice Prevention Coordinator, Family Care Community Partnership (FCCP)

Family Service RI
Full-time, $19.00 – $23.62/hr
Additional stipend!
Degree & Knowledge of Justice System Required!

Description

Due to funding from ARPA (American Rescue Plan Act), this position is eligible for a pro-rated monthly stipend up to $694.00

FSRI is always looking for candidates that want to make a positive impact on the community!  

Position Summary: The Youth Justice Prevention Coordinator works as an integral part of the Family Care Community Partnerships (FCCP) multidisciplinary team to provide specialized prevention strategies to families with children at risk for abuse/neglect. This position would focus on families within the FCCP program who have children at risk of Juvenile Justice/Wayward involvement and/or youth that are exiting the Rhode Island Training School. The Prevention Coordinator will provide intensive community-based assistance and develop and facilitate wraparound service plan with families utilizing their natural support and ensuring linkages to additional community-based providers to address identified needs to reduce further involvement in the Juvenile Justice System. The Prevention Coordinator is responsible for collaborating with service providers within the Juvenile Justice System, such as the Department of Children, Youth and Families, law enforcement, juvenile probation officers, juvenile hearing boards, RI Family Court and other community-based providers to understand trends leading to youth involvement in the Juvenile Justice system and work collaboratively to provide effective community-based prevention.   

Qualifications:

  • Associates or Bachelor’s degree strongly preferred; with knowledge of the child welfare and Juvenile Justice system
  • Ability to obtain Certified Community Health Worker certification, or ability to be certified with the first 12 months of employment
  • Ability to become certified in the Wraparound process within the first 12 months of employment
  • Experience working with at risk youth and families with complex needs, at risk of involvement with child welfare and/or juvenile justice system strongly preferred
  • Experience working with culturally diverse communities/families and demonstrated ability to be culturally sensitive and maintain confidentiality in compliance with PHI standards
  • Strong interpersonal and social skills with the ability to build and maintain relationships internally and externally with a variety of community partners
  • Excellent verbal and written communication, organization and customer service skills required 
  • Experience working with culturally diverse communities/families and demonstrated ability to be culturally sensitive and appropriate 
  • Ability to provide services in youth home and community locations
  • Maintain valid driver’s license, registration and auto insurance
  • Flexibility to work evenings and weekends as needed
  • Bilingual/ASL skills are compensated by an additional 6% above base pay
  • Multilingual skills are compensated by an additional 8% above base pay  

Physical Requirements: This position requires:

  • Travel within the community, to and from client home, agency locations, which could include using walkways, stairs and/or elevators.
  • Ability to lift up to 20 lb
  • Ability to communicate effectively

Don’t meet every single requirement?  Here at FSRI, we’re dedicated to building a diverse and inclusive workplace. If you’re excited about one of our career opportunities, but your experience doesn’t align perfectly with every qualification, we encourage you to apply anyways. You may be the perfect fit for this or another opportunity! 

Community Health Team CHW

Family Service RI
Full-time, $22.00 – $30.02/hr
Certification & Reliable Transportation Required
Bilingual Spanish Preferred

SRI is always looking for candidates that want to make a positive impact on the community we serve in!  

Position Summary: The Trauma Systems Therapy- Community Health Worker will conduct screenings and individual needs assessments in family homes and other community venues as appropriate. Responsible for engaging clients; implementing screening tools; identifying areas of need; developing action plans; ensuring referrals are made to appropriately matched services; and providing ongoing support and monitoring. Provide Enhanced Case Management (ECM) to assist the family/youth to access necessary services to improve the quality of life.  Advocates for youth and family in navigating the child welfare system.


Qualifications:

  • Community Health Worker Certification required; Bachelor degree preferred.
  • Availability to work flexible schedule to meet the needs of families, including 2-3 late evenings weekly.
  • Ability to complete training and meet all requirements to be certified as a Community Health Worker within the first 6 months of employment.
  • Spanish bilingual preferred.
  • Valid driver’s license, auto insurance and reliable transportation.
  • Ability to work independently and as an interdependent team member.
  • Ability to provide services in client’s homes, health clinic, community locations and other agency sites.
  • Ability to have a flexible schedule to include some evenings.
  • Prior experience in behavioral health and/or crisis intervention preferred.
  • Bilingual/ASL skills are compensated by an additional 6%, above base pay.
  • Multilingual skills are compensated by an additional 8%, above base pay.

Continuing Education Requirements:

  • As needed to maintain individual CHW certification and meet RI DOH standards.
  • Participation in semi-annual and annual employee performance review process including development and review of professional/program goals and objectives.
  • Other trainings as required by Rhode Island Department of Health.

Physical Requirements:

  • Travel to and from clients’ residence, community locations and office site, which could include using walkways, stairs and/or elevators.
  • Ability to lift up to 20lbs.
  • Ability to communicate effectively.

Don’t meet every single requirement?  Here at FSRI, we’re dedicated to building a diverse and inclusive workplace. If you’re excited about one of our career opportunities, but your experience doesn’t align perfectly with every qualification, we encourage you to apply anyways. You may be the perfect fit for this or another opportunity! 
 

We offer our employees a comprehensive benefits package that includes health, dental and work life benefits. Only together can we continue to grow and make a difference in our communities.
Join our FAMILY today!

Bilingual Community Health Worker, DCYF Best Start

Family Service of RI
Full-time, $22.00 – $30.02
Bilingual Spanish Required
Experience Working with Children & Families

Position Summary: CHW will conduct screenings and individual needs assessments in family homes and other community venues as appropriate. Responsible for engaging clients; implementing screening tools; identifying areas of need; developing action plans; ensuring referrals are made to appropriately matched services; and providing ongoing support and monitoring. Care coordination. Working closely with DCYF. Cases open up to 6 months.

Qualifications:

  • Associate’s degree required (2 years)
  • Bachelor’s degree (preferred)
  • Ability to complete training and meet all requirements to be certified as a Community Health Worker within the first 6 months of employment.
  • Spanish bilingual required.
  • Valid driver’s license, auto insurance and reliable transportation.
  • Ability to work independently and as an interdependent team member.
  • Ability to provide services in client’s homes, health clinic, community locations and other agency sites.
  • Ability to have a flexible schedule to include some evenings.
  • Prior experience working with young children and their families.
  • Bilingual/ASL skills are compensated by an additional 6%, above base pay.
  • Multilingual skills are compensated by an additional 8%, above base pay.

Continuing Education Requirements:

  • As needed to maintain individual CHW certification and meet RI DOH standards.
  • Participation in semi-annual and annual employee performance review process including development and review of professional/program goals and objectives.
  • Other trainings as required by Rhode Island Department of Health and DCYF

Physical Requirements:

  • Travel to and from clients’ residence, community locations and office site, which could include using walkways, stairs and/or elevators.
  • Ability to lift up to 20lbs.
  • Ability to communicate effectively.

Don’t meet every single requirement?  Here at FSRI, we’re dedicated to building a diverse and inclusive workplace. If you’re excited about one of our career opportunities, but your experience doesn’t align perfectly with every qualification, we encourage you to apply anyways. You may be the perfect fit for this or another opportunity! 

We offer our employees a comprehensive benefits package that includes health, dental and work life benefits.
Only together can we continue to grow and make a difference in our communities.
Join our FAMILY today!

Family Service of RI (FSRI) is a statewide organization with a 130 year track record of improving the health and well-being of children and families. We are passionate about our mission to advance opportunity and hope. FSRI’s diverse and inclusive teams – working across the Health, Healing, Home and Hope divisions, are experts in their fields, delivering strategies to positively impact lives. We provide services statewide, and currently operate in three locations in Providence; and four locations in East Providence, Smithfield and North Smithfield. 


Family Service of Rhode Island provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, or status as a covered veteran in accordance with applicable federal, state and local laws.


FSRI determines pay based on a candidate’s relevant and transferable experience, certifications, licenses, degree and language ability.  

Youth Support Partner/Community Engagement Specialist, Residential

Family Service of RI
Full-time/ Part-time, $23.00 – $28.60
Language Skills Compensated!
Lived Experience with Human Trafficking or child welfare involvement required

Description

FSRI is always looking for candidates that want to make a positive impact on the community!


Position Summary: The Youth Support Partner is responsible for engaging and serving at-risk youth who have been identified as potential victims of CSEC (Commercial Sexual Exploitation of Children). The Youth Support Partner will provide culturally competent services as well as use their lived experience to develop authentic relationships. The role of Youth Support Partner is to provide youth with support, trauma-informed advocacy, collaboration with families, community resources, community providers and treatment team members with the goal towards safety, self-sufficiency and empowerment.


Qualifications:

  • High School diploma or GED.
  • Lived experience with human trafficking and/or child welfare involvement.
  • Minimum of 1 years’ experience providing peer support
  • Must be willing to be certified as a Peer Support Specialist within 2 years of hire.
  • Effective communication skills to include written, conflict resolution and mediation.
  • Ability to maintain confidentiality.
  • Ability to work a flexible schedule to include some evenings and weekends.
  • Bilingual/ASL skills are compensated by an additional 6%, above base pay.
  • Multilingual skills are compensated by an additional 8%, above base pay.


Don’t meet every single requirement? Here at FSRI, we’re dedicated to building a diverse and inclusive workplace. If you’re excited about one of our career opportunities, but your experience doesn’t align perfectly with every qualification, we encourage you to apply anyways. You may be the perfect fit for this or another opportunity!


Only together can we continue to grow and make a difference in our communities.
Join our FAMILY today!

Family Service of RI (FSRI) is a statewide organization with a 130 year track record of improving the health and well-being of children and families. We are passionate about our mission to advance opportunity and hope. FSRI’s diverse and inclusive teams – working across the Health, Healing, Home and Hope divisions, are experts in their fields, delivering strategies to positively impact lives. We provide services statewide, and currently operate in three locations in Providence; and four locations in East Providence, Smithfield and North Smithfield. 


Family Service of Rhode Island provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, or status as a covered veteran in accordance with applicable federal, state and local laws.  
 

FSRI determines pay based on a candidate’s relevant and transferable experience, certifications, licenses, degree and language ability.  

Community Health Worker

Department:WIH-OBGYN
Operating UnitWomen & Infants Hospital
Location:Providence, RI
Job ID:24289
Job Status:Full Time
Shift:Days
Schedule:Mon.-Fri. 8:00am – 4:30pm

Job Summary: The Community Health Worker will support the community-based support services program. The Community Health Worker plays a critical role in assessing patient needs, offering community resources and referrals, providing navigation, support, care coordination, and ongoing case management to meet those needs. Visits patients in their homes and in the communities in which they live when necessary, providing culturally sensitive approaches to health information to improve health literacy. The Community Health Worker facilitates the patient’s decision-making and self-management to help patients engage in their overall health and achieve their health goals. This individual will be responsible for tracking patient related activities, monitoring and documenting progress. Works collaboratively with the Lead Community Health Worker and Project Coordinator to promote patient-centered care and actively participates in multidisciplinary patient-centered team meetings. The Community Health Worker has frequent contact with community partners and agencies on behalf of the patients served, networking and collaborating on resource identification to improve the overall health of the population.

Specifications: High School or GED Required; Associate’s Degree Preferred. Minimum 1 to 3 Years of experience. Community Health Worker Certification Required (or must be working towards obtaining certification within 12 months of hire). Experience working with primary care providers or in other healthcare settings. Experience working with patients regarding managing their health, navigating systems, providing care coordination and health coaching is preferred. The ability to travel to various locations in the state and reliable transportation is required. Must possess a valid, current state issued driver’s license, have reliable transportation and proof of current auto insurance required. Ability to speak a second language, Spanish preferred. Selected candidates will receive training specific to birthing people to enhance their skills.

Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting the nation’s top specialty trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case by case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.

Community Health Worker

Integra
Full-time
CHW Certification Preferred
Bilingual Spanish Preferred

Job Summary

The Community Health Worker is a member of the community health team; an interdisciplinary team comprised of Community Health Workers, In-Home team nurse care managers, schedlers, resource specialists, health navigators and nurse practitioners. Works closely with the core team members to support patients who are dealing with complex medical, behavioral health and/or substance issues as well as social determinants of health, and require a more intensive home and community-based intervention.

Duties and Responsibilities

Used to assist the Integra In-Home patients in securing community resources identified through the SDOH screening and in-home assessment.

Acting as a liaison between the patient and the community resource.

Would be responsible for the SDOH screening and assessment of the patients needs to remain in the community.

Assist with the management of the newly implemented chronic condition disease management programs for BCBS members.

The Community Health Worker plays a critical role in assessing patient needs, offering community resources and referrals, providing navigation, support, care coordination, and ongoing case management to meet those needs.

Visits patients in their homes and in the communities in which they live, providing culturally sensitive approaches to health information to improve health literacy.

The Community Health Worker facilitates the patient’s decision-making and self-management to help patients engage in their overall health and achieve their health goals.

This individual will be responsible for tracking patient related activities, monitoring and documenting progress.

Works collaboratively with the primary care team to promote patient-centered care and actively participates in multidisciplinary patient-centered team meetings.

The Community Health Worker has frequent contact with many community agencies on behalf of the patients served, networking and collaborating on resource identification to improve the overall health of the population.


Requirements

High School diploma required with a combination of training and skills to effectively carry out responsibilities and assignments (such as previous experience working with patients in a community-based setting).

Must have Certification in Community Health Work or is working toward certification, must obtain certification within 12 months.

Associates or Bachelor’s degree in Social Work, Community/Public Health or related health sciences field a plus.

Experience working with primary care providers or in other healthcare settings.

Experience working with patients regarding managing their health, navigating systems, providing care coordination and health coaching is preferred.

The ability to travel to various locations in the state and reliable transportation is required.

Must possess a valid, current state issued driver’s license, have reliable transportation and proof of current auto insurance required.

Ability to speak a second language, Spanish preferred.