Position Summary:

The Community Health Worker (CHW) plays a vital role in advancing health by providing care coordination and connecting Medicaid-eligible individuals with health and social services. In its initial phase, this role will focus on working with pregnant mothers to improve maternal and child health outcomes through participation in the nationally recognized Pathways HUB model. CHW builds trusting relationships, assesses needs, and supports individuals in navigating both health systems and community resources.

 

Essential Job Functions:

Assists with onboarding new clients and facilitates the full intake process for East End Community Services, ensuring seamless connection to programs and supports. Recruit and enroll eligible clients into the Pathways HUB program, focusing on Medicaid-ekigible pregnant individuals and families.

     Conduct outreach in clinics, emergency departments, schools, social service agencies, and neighborhoods to engage potential clients.

Contact all prospective referrals within 48 hours and assess eligibility and interest in participation. Assist eligible clients in applying for Medicaid and ensure insurance enrollment (Health Insurance Pathway). Ensure clients are connected to a primary care provider within 30 days of enrollment (Medical Home Pathway). Support clients in scheduling and attending medical appointments with appropriate providers (Medical Referral Pathway). Address social determinants of health (housing, transportation, food security, behavioral health, etc.) by opening and completing related Pathways and mal<ing warm referrals to community-based partners. Maintain an active caseload of approximately 30 clients after the onboarding/rampup period. Document all client interactions, referrals, and outcomes in a timely, complete, and HIPAA-compliant manner. Participate in at least 75% of mandatory training, team meetings, and HUB-related professional development, Represent East End and the Pathways HUB model with professionalism, empathy, and cultural humility. Embody the mission, vision, and values of East End Community Services and the WestCare Foundation in all interactions.