Community Health Specialist

Job Description

Job Description

Position Summary:

The Community Health Specialist reports to the DBHIDS SDOH Equity Unit, Associate Director. This position is responsible for supporting individuals receiving services from DBHIDS including the individuals and their households enrolled into the SDOH Supports Program. This support includes completing a Social Determinants of Health (SDOH) Screener to assess physical health, behavioral health, housing, food, income, and transportation resources needed to improve an individual’s overall quality of life. This role will assist in scheduling health-related appointments, nutrition education as well as working collaboratively with the individual’s care team to meet all health-related social needs (HRSN).

Duties and Responsibilities:

Meets with individuals and families enrolled into the SDOH Supports Program to assess needs based off the SDOH Screener, including; helping them to set health goals, coordinate/monitor plan, and complete tasks as necessary to complete recovery plan goals. Tasks may include, but are not limited to:

• Follow-up calls, visits, and door drops (office, tele/video health, community, home)
• Motivate/coach individuals to meet their health goals.
• Assist individuals with organizing their records, making follow-up appointments, and filling their prescriptions.
• Provide language/medical translation.
• Schedule medical appointments
• Provide reminder/confirmation calls.
• Assist with disease management, including symptom tracking and reporting, health education/prevention, and maintenance of individual supplies/medications.
• Make referrals to physical health/behavioral health services.
• Act as peer support which includes advocacy and relationship building.
• Verify Insurance
• Supports SDOH Equity Unit team members with completing 3 surveys with individuals enrolled into the SDOH Supports Program
• Assists individuals in accessing SDOH services via navigation in findhelp.org/PA Navigate, referrals, appointments, and completion of applications following transition/discharge from SDOH Supports Program.
• Produce monthly reports from findhelp.org/PA Navigate and present to DBHIDS leadership as needed.
• Establish a rapport with individuals and their identified support while providing general engagement and encouragement-coordinated care.
• Follow - up with individuals via phone calls and home visits.
• Help individuals set personal health related goals, including behavioral and physical health including behavioral health services, dentistry, and optometry.
• Help individuals connect with transportation resources and provide appointment reminders when needed.
• Knowledgeable about community resources appropriate to needs of individual.
• Manage assigned caseload of individuals enrolled in the SDOH Supports Program.
• Attend regular staff meetings, trainings and other meetings, as requested.
• Maintains documentation/records to include patient notes, releases of information, assessments, screenings, referrals and other documentation of record. Document activities, plans, and follow-up in an effective manner.
• Document outcomes and complete reports as needed or requested.
• Perform other duties as assigned.

Skills Required:

• Ability to work independently and as part of a collaborative clinical team as the situation requires.
• Excellent interpersonal, written, and verbal communication skills.
• Organized, flexible and ability to multitask.
• Knowledge of computer software applications (Microsoft Office Applications, Excel others)
• Knowledge of grammar, spelling, and punctuation relates to correspondence necessary to perform essential job functions.
• Knowledge of basic arithmetic to make calculations, balance and reconcile figures necessary, and make changes accurately.
• Excellent customer service skills

Education and Experience:

• High School Diploma or its equivalent.
• Experience working in a diverse, community-based setting is preferred.
• Successful completion of a Community Health Worker formal certification training program. Employee will have 12 months to complete if not holding a current certification.

Physical Demands:

• Ability to travel up to 50% of the time across the Philadelphia community, in individual’s homes or healthcare settings.
• Frequent and prolonged work at a computer and/or on the phone for extended periods of time with repetitive typing, arm and hand motion.
• Minimal lifting, bending but role typically requires long period of sitting.

Essential Functions:

Complete SDOH Screener for individuals enrolled in SDOH Supports Program and/or Trauma to Triumph programs.

Support individuals and families to linkage to community resources per their SDOH needs listed in the screener.

Collaborate closely with other members of the Systems Integration, SDOH Equity Unit and community based organizations.

Actively participate in the implementation of the resource and referral platform.

Equal Opportunity Employment:

PMHCC, Inc. is committed to equal opportunity. It is our policy to support equal employment for all employees and applicants without regard to race, religion, color, sex, sexual preferences, age, national origin, disability, behavioral health status, military status or any other characteristic protected by law.

Americans with Disabilities Act:

Employees as well as applicants who are currently, or become disabled, must be able to perform the functions of the job with either reasonable accommodation or unaided. PMHCC, Inc. will examine reasonable accommodations on a case by case basis in accordance with the law.