Community Health Worker - Pediatrics and Obstetrics

Overview

In partnership with patients, their families (as defined by the patient), and multidisciplinary teams, the Community Health Worker– Pediatrics and Obstetrics (CHW) delivers patient-centered care coordination for individuals requiring specialized services. The CHW collaborates closely with patients, parents/guardians, caregivers, healthcare providers, educational systems, and interdisciplinary teams to ensure comprehensive, integrated, and compassionate care.

Responsibilities

Essential Functions

• Interacts with patients via telehealth and in-person clinic appointments, community spaces, schools, and other locations per program guidelines.
• Serves as a point of contact for patients enrolling in services.
• Collaborates with patients, parents/guardians, caregivers, medical providers, school systems, and interdisciplinary health care teams on patient-centered care.
• Acts as a patient and family advocate to ensure that services are delivered to meet the needs of patients and families, as well as appropriate use of resources.
• Empowers patients and/or their families to be engaged and active participants in their care management.
• Conducts outreach and engagement with patients and families to identify social and community needs impacting health and well-being.
• Assists patients and families in setting achievable goals and support progress through regular follow-up and encouragement.
• Continuously monitors patients’ biopsychosocial needs and provides timely follow-up in alignment with program protocols to ensure continuity of care and support.
• Coordinates transitions between sites and providers of care.
• Coordinates and streamlines patient referrals to appropriate community-based services, ensuring timely access to resources that support health, wellness, and social needs.
• Delivers direct CHW care in alignment with program protocols in accordance with established standards of practice.
• Accurately completes all documentation related to direct and indirect patient care in a timely manner, ensuring that medical records are up-to-date, thorough, and compliant with organizational standards.
• Plays an active role in daily unit-based patient care huddles and periodic clinic-wide informational meetings, patient conferences, and planning sessions. These engagements support quality assurance initiatives, care coordination, and continuous improvement in patient services.
• Participates in ongoing professional development through seminars and educational sessions, ensuring compliance with all certification requirements while staying current with best practices in the field.
• Participates in the implementation and evaluation of quality improvement strategies to ensure compliance with evidence-based guidelines and standards, while identifying opportunities to enhance patient outcomes and care delivery.
• Ensures all tasks provided and associated with patient care, patient administrative processes, and related duties comply with all regulatory and accreditation standards including The Joint Commission and CommUnityCare
• Policies and Procedures.
• Cultivates and sustains positive working relationships and strategic partnerships with colleagues across departments - including leaders, support staff, providers, and other personnel. Communicates effectively with all members of the care team to deliver patient-centered, coordinated care.
• Engages respectfully and collaboratively with patients and their families, utilizing a trauma-informed care approach to foster trust and build positive, supportive relationships.
• Participates in community events and maintains partnerships to promote awareness of available health and social services, as assigned by supervisor.
• Performs any other duties as needed to drive the vision, fulfill the mission, and abide by the values of this organization.

Knowledge, Skills and Abilities

• Strong problem-solving abilities to effectively support both patients and staff in dynamic care environments.
• Exceptional attention to detail and accuracy in documentation, patient care, and task execution.
• Excellent communication skills, both verbal and written, to ensure clear, compassionate, and effective interactions.
• Expertise in delivering high-quality CHW services and support, aligned with professional standards and ethical guidelines.
• Demonstrated ability to manage multiple CHW responsibilities simultaneously, maintaining efficiency and quality.
• Experience in direct client engagement, including advocacy, and coordination of community resources.
• Competent with healthcare technologies and systems, such as electronic medical records (EMR), patient documentation platforms, and standard office software (e.g., spreadsheets, word processing).

Qualifications

Minimum Education

• High School Diploma or equivalent (higher degree accepted)

Minimum Experience

• 3 years of experience working within a community health setting in a health care role or a community based human service agency as a Community Health Worker (CHW), health educator, community outreach worker, or community organizer.

Required Licenses and Certifications

• CHW Certified Community Health Worker (CHW) in Texas Upon Hire
• CPW Certification Case Management for Children and Pregnant Women certification through Texas Health and Human Services Within 30 Days
• Valid TX Driver's License Upon Hire