Community Health Worker

The Community Health Worker of Financial Case Management determines eligibility for Medicaid and other government health insurances, community-based and fiscal programs for patient and families. Develops patient needs-based plan, coordinates services, participates in discharge planning and follows through to completion. This person will be the liaison to patients in high need geographic locations in the community. The primary work scope will be to recruit, engage and support those referred to the program to increase health literacy, retain health insurance coverage, gain access to community support as needed and increase compliance with appointments and care plans. New patients will be entered into the Patient Activation Measure (PAM) system. The CHW will be responsible for documentation of their patient interactions in various computer systems as required.

Key Responsibilities

• Assess under and uninsured patient and families for community, urgent and chronic care health care coverage and payer opportunities. This may include NYS/ other state, federal entitlement programs, and community – based programs.
• Administer the PAM questionnaire effectively using Insignia training program.
• Assist in the scheduling of appointments for primary care for uninsured patients.
• Provide assistance and/or referrals to obtain other essential support services such as housing, financial aid, food stamps, emergency food, clothing, transportation, translation, and child care.
• Conduct basic health assessments, assists families to identify needs, provides basic health information, and make appropriate referrals through monthly home visits.
• Provide advocacy, support and follow-up to determine if services are received and assist families with health behavior changes.
• Provide home visiting services to appropriate patients and follow up phone calls.
• Review self-pay census and ED Track Board to identify under and uninsured.
• Receives referrals from community agencies and internal health care team members.
• Initiates contacts with patient/ family/ representative to assess necessary assistance and prioritization of needs.
• Maintains reports, provide necessary documents and data by deadlines and upon request of supervision. Complete reports and data analysis to determine effectiveness of intervention.
• Documentation according to policies and procedures, and in the patient medical record and Insignia data base for all patients.
• Understanding of the verification process through insurance websites, and basic understanding of PFS billing process.
• Obtain RGHS release of information, completion of Medicaid application, necessary Department of Social Services forms, explain Medicaid and FINA processes, and follow-up needs. 
• Represent patients as appropriate with DSS and or other agencies. 
• Assist and facilitate in obtaining necessary Medicaid or health program eligibility documents; Community Outreach to obtain documentation, as necessary.
• Upholds HIPPA and RGHS policies and procedures throughout process.
• Completes clear action plans, prioritization of case load to move each case to closure.
• Serves as liaison between patient and families, RGHS Patient Financial Services, RGHS Affiliates, and community based agencies that can help patient to increase adherence and remove barriers to patient’s understanding and confidence in self-management of personal health condition/s and seeking appropriate care and provider communication.
• Collaborate effectively with interdisciplinary teams. 
• Participates in Hospital, affiliate and departmental committees where appropriate.
• Participates in Hospital, affiliate and departmental committees where appropriate.
• Participates in regular exchanges of information and presentations among Community Health Worker of Financial Case Managements, RGH team members and community agencies when appropriate.
• Participates in regular exchanges of information and presentations among Community Health Worker of Financial Case Managements, RGH team members and community agencies when appropriate.
• Stays current with local, state and federal changes that relate to Medicaid and health care access and reimbursement.
• Assist in the training and assimilation of new team members during orientation and throughout their probationary period.
• Educates patients and RGH team members on job roles, processes and programs as appropriate.
• Demonstrates an understanding of the diversity and culture of the various populations served.

Minimum Qualifications:

• BA/BS in related field with 2 years’ experience, or AAS in related field with four years’ experience, or an equivalent combination of work experience and education and certificates will be considered.
• Knowledgeable of a variety of health programs from Medicaid, federal, state, local and grant-funded programs; their regulations, processes and financial eligibility qualifications
• Demonstrated experience working with diverse populations
• Basic understanding of Motivational and Shared Decision interviewing
• Bilingual preferred
• Basic computer skills and programs proficiency
• Maintain a valid NYS license for transportation to meetings/appointments
• Has a primary residence in desired community of the patient population