Community Health Worker (SDoH) *PG/MoCo

Maryland-Care-Management-Inc; Linthicum (MD); On-site; USD 45,000 - 65,000; Full time

Job summary

Maryland Care Management, Inc. in Maryland seeks a Social Determinants of Health Care Coordinator to join MPC's SDoH team. You will conduct intake interviews, assess barriers, and coordinate short-term care and connections to community resources, working in clients' homes and in clinics.

The role partners with providers and agencies, documents encounters and plans, and helps clients navigate services, with travel to onsite locations required 50-75% and a focus on culturally competent support.

Qualifications

• High school diploma or GED required.
• Minimum 2 years experience serving Medicaid population (MD/DC area preferred).
• Bilingual English/Spanish preferred.
• CSW or CPSW certification preferred.

Responsibilities

• Conduct intake interviews and complete SDOH assessments.
• Explain program purpose and impact; help identify socio-economic barriers and develop care plans.
• Assist clients in accessing social services to address barriers.
• Partner with community organizations and local resources.
• Document encounters, contracts, and monthly reports; maintain electronic files.
• Assist patients in understanding care plans and instructions.
• Provide support during medical visits to ensure referrals are shared.
• Assist clients in utilizing community services and scheduling appointments.
• Build relationships with diverse backgrounds to reduce barriers.

Skills

Interpersonal skills

Communication

Cultural competence

Bilingual English/Spanish

Knowledge of community resources

Education

High school diploma or GED

CSW or CPSW certification preferred

Job description

This role requires being located in Montgomery or Prince George's County, Maryland.

Summary/Position Objectives

This position will be part of the Maryland Physicians Care (MPC) Social Determinants of Health (SDoH) team. This team will work directly with MPC members to address social barriers to optimal health. In conjunction with SDoH team, works closely with medical providers, primary care teams, and social services agencies to provide short-term care coordination and connection to resources and support to program clients to improve their health and general well-being through education and provision of coordination of care and services—works in both clinical and community-based settings, including client's homes.

About Maryland Care Management, Inc. (MCMI)

Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations.

Why join us?

MCMI recognizes the importance of flexibility and offers multiple work arrangements. Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans. Your future colleagues at MCMI are welcoming, friendly, and eager to help each other succeed. We are committed to Diversity, Equity, and Inclusion, providing organizational-wide social opportunities, and constantly improving our ongoing efforts to positively impact our members' lives.

What You'll Do:

• Conduct intake interviews with clients and complete the Social Determinants of Health (SDOH) assessment.
• Communicate to clients/patients the purposes of the program and the impact it may have on their well-being. Helps patients identify socio-economic issues that affect their overall health and develop health/social management plans and goals.
• Assist clients in accessing social services to address identified barriers to care.
• Partner with community organizations, governmental agencies, and local resources to develop productive relationships and programs.
• Document all client encounters and contracts made on behalf of clients; complete and submit monthly reports; maintain comprehensive electronic client files. Documents activities, service plans, and outcomes effectively achieved by clients.
• Assist patients in understanding care plans and instructions.
• Provide support and advocacy during medical visits or when necessary to ensure client’s medical needs and referrals required are being shared.
• Assist clients in utilizing community services, including scheduling appointments with social services agencies, and assisting with completion of applications for programs.
• Build and maintain positive working relationships with clients, providers, nurse case managers, agency representatives, and office staff, from diverse cultural and socio-economic backgrounds. Works to reduce cultural and socio-economic barriers between clients and institutions.

Secondary Functions

• Observe the confidentiality of member records following MPC policies and procedures.
• Must be available and willing to travel 50-75% to onsite locations throughout PG/Moco MD such as client homes or community-based organizations/health facilities.
• Work requires incumbent who provides such services in patient care or clinical areas are required to be fully vaccinated “proof of vaccination” required for this position.

Requirements

Knowledge and Skills:

• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Knowledge of community agencies and resources.
• Working knowledge of multi-system outreach programs related to health care delivery, clinical education, and health-related services.
• Ability to plan, implement, and evaluate individual client care plans.
• Knowledge of transportation of the transportation and other barriers to care that may be encountered by the client.
• Ability to communicate medical information to health care professionals and care coordinators over the telephone.

Education And Work Experience

• High school diploma or GED;
• 2 years experience in serving the Medicaid population (preferably in the MD/DC area).
• Bilingual English/Spanish speaker preferred.
• Community Support Worker (CSW) or Certified Peer Support Worker (CPSW) certification preferred.

EEOC Statement:

Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, or any other characteristic protected by law. This commitment extends to all aspects of employment, including hiring, promotion, compensation, benefits, training, social and recreational programs, and all other conditions and privileges of employment. As a healthcare organization, we recognize the vital importance of inclusivity in delivering quality care to our patients. We strive to foster an environment where individuals of all backgrounds feel respected, valued, and supported. We aim to better comprehend the unique needs of our patients and provide healthcare services that are culturally competent and sensitive. We encourage candidates from all backgrounds to apply and join us in our mission to provide compassionate and inclusive healthcare. We believe that a diverse workforce enriches our organization and allows us to better understand, connect with, and serve our diverse patient population.