Community Health Advocate - Home Visits & Care Coordination

Suvida Healthcare; Phoenix (AZ); On-site; USD 42,000 - 64,000; Full time

Job summary

Suvida Healthcare is seeking a Guia to coordinate care for a panel of patients within a multidisciplinary primary care team. The role focuses on preventive, chronic, and acute care needs and supports patients in achieving healthy lifestyle changes.

The Guia will build trusting relationships with patients and families, assist with social needs, and collaborate with providers, nurses, and care managers to improve outcomes. Preference given to bilingual candidates and CHW-certified individuals.

Qualifications

• Community Health Worker certification is required or preferred.
• Bachelor’s degree is preferred.
• Experience coordinating care with community resources and governmental agencies.

Responsibilities

• Provides comprehensive care coordination to an assigned patient caseload.
• Collaborates with patients, family, caregivers and healthcare providers to meet complex social needs.
• Promotes integrated care through effective team communication.
• Intervenes with patients and families regarding emotional, social, and financial aspects of illness.
• Conducts in-person visits to patient homes as needed.
• Documents interventions in patient records and care management systems.
• Onboards patients to Suvida model and care visits.
• Offers patient education on disease management and preventive care.
• Engages with patients remotely via phone, video, or text.

Skills

Care coordination

Senior/Geriatric experience

Bilingual English/Spanish

Communication skills

Teamwork

Cultural competency

EMR proficiency

Referral coordination

Education

CHW certification

Bachelor’s degree (preferred)

Tools

EMR systems

Referral management software

Microsoft Office

Job description

Suvida Healthcare is seeking a Guia to coordinate care for a panel of patients within a multidisciplinary primary care team. The role focuses on preventive, chronic, and acute care needs and supports patients in achieving healthy lifestyle changes.

The Guia will build trusting relationships with patients and families, assist with social needs, and collaborate with providers, nurses, and care managers to improve outcomes. Preference given to bilingual candidates and CHW-certified individuals.