The Community Health Advocate will be responsible for helping patients and their families to adopt healthy behaviors and navigate /access community resources. As a priority, will actively promote, maintain, and improve the health of patients and their family by providing services such as blood pressure screening and completing social need assessments. Supports medical providers through an integrated approach to care management and community outreach by providing social support and informal counseling, and advocating for individuals and their community health needs. Community outreach, such as home visits and health screenings, may be required.

Primary Responsibilities

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job responsibilities performed.

• Acts as a patient advocate and liaison between the patient/family and community service agencies (i.e. Healthcare providers, support groups, etc.)
• Conducts intake interviews with patients, including enrolling and/or referring patients to healthcare provider.
• Provides referrals for services to community agencies as appropriate. Be knowledgeable about community resources appropriate to needs of patients/families.
• Responsible for establishing trusting relationships with patients and their families while providing general support and encouragement.
• Provides ongoing follow-up with patients via phone calls, home visits and visits to other settings.
• Works closely with health care team to help ensure that patients have comprehensive and coordinated care. Follow-up with patients should be continuous from initial identification through closure.
• Responsible for providing consistent communication to the Care Management Team
• Serves as coordinator to evaluate patient/family status, ensuring that provided information, and reports clearly describe progress.
• Records patient care management information in the EMR (training provided) and other software no later than 24 hours after patient contact.
• Attends regular staff meetings, trainings, and other meetings as requested.
• Manages assigned caseload of patients.
• Performs related duties as assigned.

Education & Experience - Required

• High school diploma or equivalent.
• Must have reliable transportation and valid motor vehicle operators license.

Education & Experience - Preferred

• Certification as a Medical Assistant or Certified Nursing Assistant preferred.
• Experience working in a multi-cultural community-based setting preferred.
• Certified Medical Interpreter preferred.

Knowledge, Skills, & Abilities

• Written and oral fluency in English required.
• Demonstrated excellent verbal communication and interpersonal skills along with highly effective critical thinking skills.
• Self-motivated and function within an interdisciplinary team.
• Have the ability and willingness to provide direct support, encouragement and motivation to clients.
• Proficient understanding of community resources.
• Effective use of an EMR, email, Microsoft word and excel.