Senior Community Health Worker & Care Coordination

University Hospitals; Bedford (OH); On-site; USD 38,000 - 60,000; Full time

Job summary

University Hospitals is seeking an Advanced Community Health Worker to support Care Transitions. The role focuses on patient education, connecting patients with resources, and coordinating care with social workers, nurses, and providers to improve outcomes.

You will actively engage with the community, protect patient privacy under PHI/HIPAA, and facilitate referrals while addressing barriers to care and attendance. This is a patient-centered, collaborative position within UH’s care teams.

Responsibilities

• Provide patient education and connect patients with resources within Care Transitions, UH, and community partners.
• Coordinate with patients to assess needs and identify community resources and appropriate referral sources.
• Handle complex care cases within the CHW scope of practice.
• Collaborate with Social Worker, RN, care team and Providers for care coordination.
• Engage in community work as a volunteer and utilize connections to facilitate patient care.
• Act as liaison between patient and family and care team.
• Address missed, declined, and rescheduled visits and identify barriers to attendance.
• Protect PHI and follow HIPAA with proper contacts and consent.
• Maintain ongoing communication between disciplines and referrals.
• Guide patients as they progress through the healthcare system and community.
• Collaborate with peers and system resources to address patient concerns promptly.
• Identify patient safety concerns and work with Social Worker to address them.
• Refer to Social Worker for complex/clinical issues.
• Demonstrate knowledge of patient history and summarize it from chart review.
• Manage daily and weekly tasks, documentation, and follow-up reports.
• Maintain professionalism and ethics in high-stress situations.
• Display strong IT literacy to manage referrals, documentation, and resource connections.

Skills

Patient education

Care coordination

HIPAA compliance

PHI handling

Interpersonal skills

Job description

University Hospitals is seeking an Advanced Community Health Worker to support Care Transitions. The role focuses on patient education, connecting patients with resources, and coordinating care with social workers, nurses, and providers to improve outcomes.

You will actively engage with the community, protect patient privacy under PHI/HIPAA, and facilitate referrals while addressing barriers to care and attendance. This is a patient-centered, collaborative position within UH’s care teams.