Lead Community Health Worker

Yale New Haven Health; New Haven (CT); On-site; USD 52,000 - 78,000; Full time

Job summary

Yale New Haven Health is seeking a Lead Community Health Worker to guide navigation initiatives, collaborate with internal and external partners, and improve patient pathways across the health system. The role reports to the Manager, Patient Navigation and supports CHW staff development.

Ideal candidates will have 3+ years in healthcare or human services, an Associate's Degree, and the ability to obtain CHW certification within a year.

Qualifications

• Minimum of an Associate's Degree with community health exposure.
• At least 3 years' experience in health care or human services.
• Experience as case manager, CHW, or patient navigator preferred.
• State CHW Certification preferred or ability to obtain within 1 year; valid driver's license required.

Responsibilities

• Lead CHW navigation programs and coordinate with internal and external stakeholders.
• Provide problem solving navigation for high‑risk patients and monitor referrals.
• Develop training materials and schedule for CHW staff and ensure milestones are met.
• Maintain accurate patient records and supervise CHW team activities.
• Engage community partners and participate in quarterly meetings to evaluate referrals.

Skills

Communication skills

Bilingual Spanish

Education

Associate's Degree

Job description

Overview

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

Under the supervision of the Manager, Patient Navigation, the Lead Community Health Worker serves as a lead for healthcare and community-based navigation for referred patients. Responsibilities include working collaboratively on the development and implementation of a new and existing navigation programs with key internal and external community stakeholders and partners, monitoring and triaging patient referrals for navigation, supporting the Manager and CHW team by providing problem solving navigation for high-risk patients. The Lead Community Health Worker is seen as the go-to person for CHW navigation needs and is a valued resource between the HCW Resource Hub, within the Office of Health Equity, across the health system and in our Delivery network communities.

EEO/AA/Disability/Veteran

Responsibilities

• Supports The Office of Health Equity, Community Health Worker Hub Development
  • Provides insight, support and input for department planning
  • Assists the YNHH Manager with developing the screening and navigation policies and procedures documents
  • Delivers program training for all referral departments across the system
  • Works collaboratively with Manager other key stakeholders to implement program milestones at key intervals as outlined
  • With support from the Manager, develops training manual and materials for CHW
  • Engages community partners for participation
  • Supports Manager through interview and selection process for CHW's to be hired
• Provides training and department orientation to newly hired CHW's as appropriate
  • Develops training schedule for program CHW's (including but not limited to training in Epic, motivational interviewing, patient engagement, cultural competency, evaluation process, navigation steps patient discharge etc.)
  • Provides training to newly hired CHW's ensuring that key milestones are met and staff are progressing through learning objectives
  • Works collaboratively with Manager and team on patient data management and recommends changes and modifications to the system as appropriate
• Serves as the organizational lead for community resources
  • Meets with community partners regularly to evaluate service referrals
  • Engages new community partners as necessary for patient needs
• Supports and provides oversight for referred patients to the CHW Resource Hub
  • Establishes rapport with patients, family and caregivers; exhibits naturally friendliness and helpfulness
  • Monitors program data and works collaboratively with Manager to monitor high -risk patients
  • Monitors navigation processes for patients and recommends appropriate changes as necessary
  • Meets with patients troubleshoots questions and problems as they arise being solution oriented
  • Monitors the enrollment of eligible patients in navigation program
  • Provides referrals to other local agencies as appropriate for services
• Provides navigation services, as needed, to patients enrolled navigation programs
  • Assist with providing patient reminder calls for all appointments
  • Assists patients with referrals for transportation services to appointments as necessary
  • Assists with the coordination of interpreter services as appropriate for patient appointments
  • Other related duties or special projects as needed and assigned
• Maintains accurate patient records and processes client records appropriately
  • Ensures that all necessary patient information is documented in patient (paper and electronic) files
  • Maintains patient records securely
  • Documents all client interactions in electronic database with accurate notes indicating interactions with patients
• Participates in physician awareness and community partnership meetings
  • Attends, as appropriate, meetings with hospital and community physicians and partners
  • Participates in and contributes to weekly team meetings
  • Develops in-service for screening and referral sites
• Provides Community Health Worker staff supervision
  • Is seen as the go-to person for CHW staff questions
  • Shares feedback with manager for annual performance review
  • Assigns work related tasks to the CHW team and monitors progress and outcomes

Qualifications

EDUCATION

• Minimum of an Associate's Degree, combined with with prior experience supporting and working within the community (Greater New Haven, Bridgeport, New London, Greenwich/Port Chester). Community Health Worker and/or Patient Navigator training preferred.

EXPERIENCE

• At least 3 year's experience in health care or human service setting showing progressive increase in responsibilities.
• Experience in positions such as case manager, community health worker and patient navigator preferred.
• Excellent oral and written communication skills.

LICENSURE

• State CHW Certification preferred or ability to obtain certification within 1st year of employment.
• Valid Drivers License required.

SPECIAL SKILLS

• Bilingual Spanish preferred.