Position Summary:
Under the direction of the Behavioral Health Manager, the Community Health Worker (TEAM First) partners with primary care and behavioral health providers to improve the identification of child-caregiver needs through proactive screening and supports improved health outcomes for children and families. CHW builds trusting relationships with patients and caregivers by providing culturally responsive education, care coordination, and support to address medical, behavioral, developmental, and social needs. The CHW helps families navigate healthcare, school, and community systems while reducing barriers to care. This role promotes patient empowerment, connects families to resources, and collaborates with the care team to ensure coordinated, patient-centered services.
Minimum Qualifications:
- High School Diploma with 4 years of community health or behavioral health setting OR Associates Degree with 2 years of related experience, or Bachelor's Degree in Social Work, Early Childhood, Psychology or related degree.
- Excellent communication skills.
- Proficiency with Microsoft Word, Excel, and PowerPoint is required.
- Bilingual English/Spanish is required.
- Strong attention to detail.
- Experience with data entry.
- Time management skills.
Key Duties:
- Manage an assigned caseload of patients and caregivers, providing ongoing outreach, support, care coordination, and follow-up to improve health outcomes and close gaps in care.
- Build trusting relationships with patients and caregivers using evidence-based engagement techniques, including Motivational Interviewing (MI) and problem-solving strategies, while assessing strengths, barriers, and readiness for change.
- Assist patients and caregivers in developing goals and action plans that promote treatment adherence, healthy behaviors, and self-management and document a BH specific care plan in the patients' electronic medical record.
- Provide culturally responsive education on physical, developmental, behavioral, and mental health topics, including child development, disease prevention, treatment options, and available community resources.
- Strengthen patients' and caregivers' self-advocacy and self-management skills by helping them navigate healthcare, school, and community systems and overcome barriers to care.
- Provide psychoeducation to help patients and caregivers recognize changes in health status, identify escalating symptoms, and understand when to seek appropriate care.
- Coordinate care across medical, behavioral health, educational, and community settings by facilitating referrals, scheduling appointments, supporting transitions of care, and ensuring continuity of services.
- Collaborate with primary care providers, behavioral health clinicians, patients, caregivers, and other members of the interdisciplinary care team to implement patient-centered care plans and monitor progress.
- Improve the identification of child-caregiver needs through proactive screening.
- Connect patients and families with community resources and supportive services that address behavioral health, developmental health, and health-related social needs.
- Maintain accurate, timely, and confidential documentation of patient interactions, interventions, referrals, and outcomes in the patients' electronic health record.
Work Environment Type, Location, and Schedule:
Onsite, Bronx, NY, Monday - Friday 8am to 5pm.
Compensation:
Minimum $47,000/year; Maximum $50,000/year
About Urban Health Plan:
At Urban Health Plan (UHP) our mission is to continuously improve the health of communities and the quality of life of the people we serve by providing affordable, comprehensive, quality, primary and specialty health care and by assuring the performance and advancement of innovative best practices. At UHP, our commitment to provide patient-centered, holistic, quality health care, is part of a tradition started by our founder, Dr. Richard Izquierdo, more than 50 years ago. That tradition continues today by promoting excellence in everything that we do.
Benefits Include:
- Fully funded Health Insurance for yourself
- 73.5% funded Health Insurance for your family
- Dental Insurance
- $50,000 term life Insurance
- 401(k) Retirement Savings (including annual UHP Contribution)
- Comprehensive time off including paid vacation, personal time, sick time, and paid holidays (including your birthday!).
UHP is an equal opportunity employer. M/F/D/V. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex, sexual orientation, gender identity, gender expression, national origin/ancestry, citizenship status, disability, age, marital or family status, and military or veteran status.