Job Description

Salary

Starting at $24.00 / hr

The Community Health Worker is a non-clinical, clinical-adjacent role that supports higher-complexity member needs through a combination of community-based engagement, quality execution, and operational support. This position is designed for individuals with demonstrated experience working with medically complex or vulnerable populations.

The Community Health Worker conducts in-home and community visits, supports social determinants of health (SDOH) interventions, assists with documentation review and gap closure activities, and participates in quality-related workflows including audits, readiness activities, and corrective actions. The role works closely with Care Managers, Quality, and Operations teams to support compliance, member safety, and service effectiveness while remaining an individual contributor without supervisory or measure ownership responsibilities.

Responsibilities

Member-Facing & Community-Based Support

• Conduct in-home and community visits to assess member safety, stability, service utilization, and overall well-being.
• Identify and document changes in member condition, environment, or service effectiveness.
• Support SDOH interventions by identifying barriers, facilitating referrals, and ensuring follow-up on community-based resources.
• Promote member engagement, education, and advocacy while reinforcing independence and appropriate service use.
• Communicate findings, concerns, and follow-up needs to Care Managers and interdisciplinary team members.

Clinical-Adjacent & Care Coordination Support

• Assist with documentation review to support care planning, audits, and quality requirements.
• Support gaps-in-care identification and closure activities in collaboration with Quality and Care Management.
• Participate in care coordination escalation workflows as appropriate, without assuming clinical decision-making authority.
• Support monitoring of member satisfaction and service delivery concerns.

Quality & Operational Support

• Participate in internal audits, audit readiness activities, and corrective action follow-up.
• Support execution of quality initiatives without ownership of quality measures or programs.
• Review dashboards and reports to both interpret trends and act on identified gaps or findings.
• Assist with data collection, validation, and operational follow-through related to quality and compliance efforts.
• Provide surge support across Care Navigation and Quality functions as operational needs require.

Documentation, Compliance & Professional Practice

• Complete timely, accurate, and detailed documentation in the EMR in accordance with organizational standards.
• Maintain confidentiality and compliance with HIPAA, Medicare, Medicaid, and organizational policies.
• Adhere to safety protocols during home and community visits.
• Represent the organization professionally in member homes and community settings.
• Participate in team meetings, case reviews, and required trainings.

From

Up to

Qualifications

• Minimum of two (2) years of experience in care coordination, care navigation, community health, quality support, or a related healthcare operations role.• Experience working with Medicare, Medicaid, MLTC, or other complex healthcare populations required.• Experience working with frail, elderly, or chronically ill populations preferred.• Demonstrated experience with EMR/EHR systems and healthcare documentation.• Associate degree in Health, Social Work, Human Services, or related field preferred or equivalent relevant work experience.• Reliable transportation required for in-home and community-based visits.• Bilingual (English/Spanish or other languages) preferred.

EOE Statement

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.