Community Health Worker, Transitions of Care Program (Full Time, Day)

Job Title: Community Health Worker,
Department: RRH Ambulatory Care Management
Location: Riedman Campus
Hours Per Week:  40
Schedule:  M-F 8-4:30


SUMMARY:
The Community Health Worker (CHW) serves as a liaison among RRH patients and their healthcare providers, social services, and community-based organizations. The CHW plays an essential role, focusing on health advocacy, health education and health navigation supports aiming to improve health outcomes and overall health literacy, and to prevent the development and/or progression of adverse health conditions. As part of the Transitions of Care Program, the CHW provides coordination of care, patient support, and linkage to community services for individuals for 30 days post a hospital discharge.

RESPONSIBILITIES:
Key Responsibilities:

• Completes initial assessment for new, eligible participants with a particular focus on high risk, vulnerable populations.

• Establishes and maintains trust with participants on caseload.

• Provides referrals and linkage to services as well as support and advocacy for participants.

• Maintains accurate and complete record documentation and data collection.

• Demonstrates knowledge of community resources and how to access them.

• Conducts home visits to assess participant needs and concerns as they relate to their recent discharge, current medical conditions, and overall health.

• Reduces stigma and other barriers to initiating or continuing healthcare by providing culturally/linguistically competent, reliable information to both community members and healthcare providers.

• Participates as a member of various teams as needed.

• Represents RRH in meetings with participants, community organizations, providers and others

• Develops collaborative relationships with healthcare and social service providers to best serve their participants' needs.

• Attend community activities that are pertinent to their work as appropriate.

• Assists in completing program goals and requirements, and other duties as assigned.

Works under the direction of a Registered Nurse as a member of a multi-disciplinary care team including LPNs, Social workers, pharmacists, and others.
Ability to travel during the workday as needed

Minimum Qualifications:
• One years’ work experience in a community based, healthcare, or health and human services setting.

Required Licensure/Certification:
Valid NYS driver’s license.

Desired Attributes:
• Associates Degree, Human Services preferred.
• Fluency in Spanish.
• Ability to communicate easily with others, displaying empathy and respect and demonstrating active listening skills.
• Strong verbal, written, and interpersonal skills required.
• Proficiency in Microsoft Office products and ability to work various software applications.

EDUCATION:

LICENSES / CERTIFICATIONS: 

PHYSICAL REQUIREMENTS:

Drive - Clinical - Roles in this category require frequent driving combined with mobile clinical care across settings such as emergency response, mobile clinics, and home health environments. Staff must repeatedly enter and exit vehicles, occasionally lift and carry equipment weighing up to 100 lbs. or more, and perform care within patients’ homes or other confined, unpredictable, or uncontrolled environments. These positions demand strong fine and gross motor control, firm grasping, and heightened visual and auditory awareness to ensure safe and effective care delivery. Emotional and cognitive demands are substantial due to rapid decision‑making, direct exposure to critical or sensitive situations, and independently managing patient care in the field or home setting. Environmental exposures may include traffic hazards, infectious agents, extreme temperatures, variable home conditions, and hazardous materials. Valid licensure, physical readiness, and flexibility for extended or on‑call schedules are typically required.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

$19.50 - $23.81Rochester14617

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.