Job Location : Nebraska City,NE, USA
CHI Health St. Mary's has served Nebraska City and the surrounding areas since 1927. In the fall of 2014 St. Mary's opened the doors of a brand-new fully modernized facility. The new 110000-square-foot campus is better equipped to meet the changing needs of our communitywith among other benefits an increased capacity for specialty clinics and an integrated primary care clinic. St. Mary's encourages collaboration and care coordination among primary care physicians and medical specialists. This contributes to the high quality of care our patients have come to expect.
JOB SUMMARY / PURPOSECommunity Health Workers (CHW) provide non-clinical interventions to engage patients in their care and connect them to community support. This person plays a crucial role in helping patients and their support networks navigatehealthcare systems and access community resources. The CHW will assist in care management through outreach, social support, and informal counseling, fostering positive relationships with patients while advocating for their health needs.
The CHW will provide support to participants by providing referrals to community based organizations for identified needs (e.g., transportation, food, and housing) that directly impact the participant's short- and long-term health. TheCHA will be an integrated part of CHI Health and will work directly with participants, as well as build and maintain relationships with community resource partners. The CHW may work in the clinic, Emergency Department, otherhospital settings, in the community and in the patient's home depending on program needs.
ESSENTIAL KEY JOB RESPONSIBILITIES1. Working with clinicians, nursing staff, and other care team members to identify patients with Substance Use Disorder (SUD).2. Conduct initial assessments, obtain patient histories, and provide brief interventions that introduce options for SUD services, including Medication for Addiction Treatment (MAT).3. Facilitate MAT initiation with on-site clinicians, coordinating with outpatient providers, and ensuring seamless access to pharmacy services.4. Collect and maintain health-related social needs screening data and documenting patient interactions in the electronic medical record (EMR), and other program documentation in a timely manner.5. Establish trusting relationships with patients and their support teams, providing guidance, encouragement, and ongoing follow-up. Assist patients with completing necessary applications and registration forms. Act as a peer support and advocate for participants as they navigate the medical and social service system.6. Coordinate with healthcare providers, services, and community agencies to ensure patients receive appropriate support.7. Provide referrals for community services, including transportation resources, financial counseling, primary care, mental health services, and residential treatment facilities. Identify and link participants and families to community resources and services, assisting with coordination as necessary.
8. Offer continuous follow-up via phone or in-person visits to track patient progress, encourage appointment attendance, and remind patients of upcoming commitments.9. Support the hospital Narcan Naloxone Distribution Program.10. Verify eligibility, complete consent form, and all documentation (Release of Information, Demographic Form, Visit Form, Progress Form and Standard Pathways) and tools as needed for enrolling the population being served;11. Work with enrolled participants and families on needs that could affect the participant's health, and connect them to community-based resources and services to remove barriers to care, including transportation issues, housing, financial concerns, etc. 12. Build and maintain relationships with local networks of resource providers including: attending local coalition and partner meetings as needed; identify gaps in community resources based on participant needs.13. Play a consistent and active role in identifying project inefficiencies and collaborative solutions.14. Collecting and compiling data for monthly or quarterly counts of targeted metrics, such as number of patients served, buprenorphine administrations, prescriptions, referrals to care, etc. for program reporting. Attend team meetings and care conferences as appropriate as well as grant required training and meetings.
The job summary and responsibilities listed above are designed to indicate the general nature of the work performed within this job. They are not designed to contain or be interpreted as a comprehensive inventory of all job responsibilities required of employees assigned to this job. Employees may be required to perform other duties as assigned.
Required Education and Experience
Required Licensure and Certifications
Required Minimum Knowledge, Skills, Abilities and Training
PREFERRED Qualifications