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The community Health Worker will act as the liaison between University of Cincinnati Medical Center patients and "medical homes "or community based healthcare providers. The primary goal of the Community Healthcare Worker will be to: Identify patients who are in need of primary care, medical home, community providers and UC Health outpatient services. Educate and direct patients to available community based healthcare services. Facilitate and monitor patient's transition into medical homes and community based healthcare services.

Minimum required: Associate's Degree or 2 years of college coursework. - Healthcare or Social Work. Preferred: Bachelor's Degree - Healthcare or Social Work. | Ohio Community Health Workers (CHW) certificate required. | Minimum Required: 3 years of Healthcare experience with an Associate's Degree. Preferred: 1 year of Healthcare experience with an Bachelor's Degree.

Required Skills and Knowledge:

• Demonstrates effective problem solving/decision making abilities.
• Effective communicator with ability to speak to large groups as well as individuals from all backgrounds (both in person and over the phone).
• Ability to communicate with clinical staff with basic clinical terminology.
• Able to work in fast passed environment where conditions can change rapidly.
• Working knowledge of local community-based healthcare network.
• Working knowledge of general computer operating systems, specifically Microsoft Office programs (Word, Excel and PowerPoint).
• Working knowledge of hospital terminology, policies and procedures.
• Knowledge of persons in crisis.
• Knowledge of accepted ethical standards within the medical community and professional organization.

PATIENT POPULATION - (CLINICAL ONLY)

Engages in population appropriate communication. Has knowledge of growth and development milestones and tasks. Gives clear instructions to patients/family regarding treatment. Involves family/guardian in the assessment, initial treatment and continuing care of the patient. Identifies any physical limitations of the patient and deploys intervention when necessary. Recognizes and responds appropriately to patients/families with behavioral health problems. Interprets population related data and plans care appropriately. Identifies and responds appropriately to different needs resulting from, unique psychological needs or those associated with religious / cultural norms. Performs treatments, administers medication or operates equipment safely. Recognizes and responds to signs/symptoms of abuse or neglect.

Patient liaison for medical homes:

• Identify patients who are in need of medical home services or community based health care services. Collaborate with ED care team and proactively monitor ED tracking system to identify patients who are in need of medical home services and healthcare access education.
• Provide information, education and resources to patients to assist them in overcoming barriers to accessing healthcare and in following through with scheduled visits. Set appointments for patients with community medical homes, health service providers and UC Health outpatient services. Provide informal counseling, social support, and culturally appropriate health education. Contact patients for appointment reminders. Act as advocate for patients and families with community medical homes: and health service providers. Follow up with patients and providers after scheduled appointments. Facilitate conflict resolution.

Community Relationship:

• Build and foster relationships and collaborative with community medical homes and other community based health service providers. Collaborate with UC Health clinical departments and ancillary services to ensure efficient patient transition to the outpatient clinics.
• Maintain an updated database of community medical home facilities. Maintain database of outreach work and referred patients. Generate database to measure community healthcare programs success. Benchmark internal processes to improve practice and demonstrate efficiency through appropriate use of resources. Enter tracking data into Care Scope.