Employment Type:

Full time

Shift:

Description:

POSITION PURPOSE

Provides tailored health education, social support, connecting to health care and community-based resources and advocates for patients and their family, with a focus on specific diseases, conditions, and populations that experience health disparities. Delivers and facilitates evidence-based programs and interventions to prevent and improve management of chronic disease. Uses a specialized protocol and curriculum to provide assessments and education to patients and program participants. Assists with data collection and interpretation to understand patient and intervention-related outcomes. Plays a key role in building individual capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, health education, informal counseling, social support, and advocacy. Works collaboratively with other health care and community-based providers to improve patient health outcomes and reduce racial, ethnic, and economic disparities in those outcomes.

ESSENTIAL FUNCTIONS

1. Knows, understands, incorporates, and demonstrates our Trinity Health Mission, Values, Vision, Actions and Promise in behaviors, practices, and decisions.

2. Provides high-value services to patients with complex social and health needs, in clinical and community-based settings. Delivers evidence-based programs and interventions with fidelity to patients assigned to their caseload. Assists with identifying, engaging, and enrolling individuals that may be eligible for CHW interventions and evidenced-based programs. Conducts and interprets assessments to learn patients’ social needs, reduce barriers and connect to appropriate resources and services. Facilitates access to health and human services for patients through in-person interactions and coaching. Provides culturally appropriate support and follow-up to encourage behavior change and achieve health-related goals. Shares insight and expertise, such as patients’ customs/beliefs with providers and works collaboratively to promote culturally appropriate services.

3. Utilizes multiple system applications for caseload management, data collection, and reporting. Uses electronic health record and intervention-specific protocols for care coordination and documentation. Uses applicable resources, services, and processes to complete relevant referrals and applications in a timely manner. Incorporates basic knowledge of Trinity Health policies, practices & processes to ensure quality, confidentiality & safety are prioritized. Demonstrates knowledge of departmental

processes & procedures & ability to readily acquire new knowledge. Collaborates on performance improvement activities as indicated by program outcomes & patient experience.

4. Employs effective & respectful written, verbal & nonverbal communications; Develops an environment of mutual confidence & trust through collaborative relationships; Effectively communicates goals, standards, program expectations, service performance & how the work serves Trinity Health objectives. Serves as a liaison between health care and social service providers and patients to improve communication and coordination of services. Provides support to patients via phone and in-person interactions at the patient’s home, in the community, or at the clinic setting.

5. Performs work in a caring, collaborative & safe manner that complies with regulatory standards. Maintains a safe, functional & organized workspace environment. Stewards productive use of resources (e.g., people, financial, equipment, supplies, materials) to achieve assigned commitments, experiences & quality standards. Accountable for continuous role-based self-development & leadership growth. Supports the professional growth of team members. Self-monitors & initiates corrections and/or seeks assistance or guidance when needed. Other duties as needed and assigned by the supervisor.

6. Other duties as needed and assigned by the supervisor.

7. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

MINIMUM QUALIFICATIONS

1. Must possess a high school diploma or GED and at least one (1) year of community involvement experience, including volunteer experience.

2. Must possess a comprehensive knowledge of the lived experiences (such as experiencing poverty, food insecurity, housing instability, substance use, etc.) and/or cultural background of the patient community in which this position will work in and/or with as normally obtained through personal and/or professional experience.

3. Must complete CHW training/certification within 6 months of employment and maintain CHW training/certification per Trinity health guidelines and/or State sanctioned guidance.

4. Must possess a apecialized training/certification or demonstrated substantive knowledge in a specialty track and/or evidence-based intervention (e.g., asthma, diabetes, behavioral health, gerontology, etc.).

5. Must be comfortable operating in a collaborative, shared leadership environment.

6. Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

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Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.