Social Care Network / Community Health Worker

Description Title: Social Care Network (SCN) Community Health Worker- This position is a hybrid position Reports to: Care Coordination Program Supervisor Job Objectives: This position systematically identifies, assesses, refers, and monitors high-need individuals to ensure access to essential services. By building and maintaining key service connections, the Community Health Worker utilizes a screening tool to identify the health and social needs of Medicaid recipients. This role is pivotal in identifying individuals eligible for Enhanced NON-Health-Related Social Needs (HRSN) Services, facilitating appropriate referrals, and ensuring necessary linkages and support systems are in place. This position is grant-funded through March 2027. Responsibilities: · Engages directly with individuals seeking assistance. · Administers the Health-Related Social Needs Screening Tool to identify needed areas of support. · Facilitate referrals to appropriate community resources and healthcare providers. · Provide ongoing support to individuals until appropriate resources are secured and their identified needs have been addressed. · Collaborate with the Care Team to ensure timely follow-up and service linkage. · Use online referral systems and databases to track and manage client referrals. · Advocate on behalf of clients to access necessary services and address barriers to care. · Educate clients about available community resources and assist them in navigating healthcare and social service systems. · Accurately document screening results, referrals, and client interactions in electronic systems. · Maintain detailed and organized records in compliance with organizational policies and standards. · Work closely with the Care Team, including care coordinators and other healthcare professionals, to ensure holistic client care. · Participate in regular team meetings and contribute insights on client progress and community resources. · Engage with community organizations to strengthen service networks and improve referral pathways. · Build relationships with community organizations and service providers. · Conduct outreach to identify individuals in need of services. · Provide occasional in-person support to clients when necessary. Represent MHA at meetings as necessary Requirements Qualifications: Education: · Minimum of High School Diploma or GED. Experience: · Minimum of 1 year in human services experience preferred. · Effective written and oral communication skills. · Experience with Health Homes highly preferred. · Experience with Electronic Health Record Program(s) preferred. · Ability to work independently with minimal direct supervision. · Must be organized, self-motivated and can coordinate multiple tasks simultaneously. · Ability to exercise sound judgment under crisis situations and to abide by regulations regarding confidentiality. Other Duties: · The duties outlined above are intended to describe the essential job functions, the general supplemental functions and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time. Terms of employment/benefits: · Non-Exempt. · Paid vacation, personal and sick leave according to MHA policy.