Community Health Worker Certified-2

Location: Work from home (Pennsylvania) Shift: Days (United States of America) Scheduled Weekly Hours: 40 Worker Type: Regular Exemption Status: No Job Summary: The Certified Community Health Worker (CCHW) within the Social Needs Resource Hub (SNRH) provides patient-centered outreach, primarily through telephonic engagement, to individuals with identified social needs. Working within a team-based model, the CCHW collaborates with healthcare teams, community-based organizations (CBOs), and hub colleagues to assess needs and coordinate appropriate support. The CCHW utilizes motivational interviewing and problem-solving techniques to educate patients and connect them to community resources that address social determinants of health, including transportation, food insecurity, housing, financial strain, and utilities. This role includes facilitating referrals and partnering with CBOs through the Neighborly platform to ensure timely and effective linkage to services. The CCHW conducts follow-up outreach to confirm successful connections and address barriers, supporting a shared team workflow and accountability model. Accurate and timely documentation within Geisinger’s electronic medical record (EMR) is required to capture outreach efforts, referrals, and outcomes, supporting reporting, quality improvement, and program evaluation Job Duties: Orients   and   assesses new   Community   Health   Workers. Provides   regular assessment   of   the   level   of   proficiency   demonstrated   by   staff   during the   orientation   period   in   order   to   support decisions to move staff along in training or refocus until proficiency is met. Assists   in   the   identification   and   outreach   of   medically   complex patients. Collaborates   with   the   multidisciplinary   team   in   the   development   and   implementation   of   the   care   plan. Engages   patients by   way   of   phone   call, home   visit,   hospital visit,   and   accompanying   patients   to   Providers   appointments   as   needed. Completes   vital   signs. Identifies   gaps   in   care   and   connects   members with   resources. Facilitates   telemedicine   visits with   members   and   providers. Performs   disease   specific   education. Conducts   Medication   Review   to   ensure   medication   adherence. Conducts   safety   evaluations   in   patients   home. Facilitates   adherence   to   treatment   plan   by   early   identification   and   resolution   of   gaps   in   care. Communicates   all   concerns to   clinical   team   and   manager as   necessary,   seeking support   and   guidance proactively. Participates   in   multidisciplinary   team   conference   in   order   to   maximize   the   treatment   plan. Provides   reinforcement   of   the   treatment   plan   under   the   direction   of   the   Case   Manager   and   Licensed   Social Worker   and is available for consultation and case review as needed. Work is typically performed in a clinical environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position. Position Details: Education: High School Diploma or Equivalent (GED)- (Required) Experience: Minimum of 1 year-Related work experience (Required) Certification(s) and License(s): Certified Community Health Worker (CCHW) - Pennsylvania Certification Board Skills: Clerical I, Communication, Multitasking, Problem Solving OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION : We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family.  We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all.  We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.