Community Health Worker, Hospital Care Transition Program

Job Location: South County Hospital - Wakefield, RI

Salary Range: Undisclosed

About RIPIN: RIPIN deploys a peer model to support people with special healthcare and education needs across the whole lifespan. Founded in 1991 by a group of parents of children with special needs, RIPIN continues to be peer-led: a majority of our board and more than three-fourths of our staff are parents or caretakers of loved ones with special needs. RIPIN’s peer professionals now help more than 45,000 Rhode Islanders every year navigate healthcare, schools, and other support systems.

Job Summary: The Community Health Worker (CHW) is a peer who has experience in navigating Rhode Island’s health system for themselves, a family member or through previous employment. This CHW will work in RIPIN’s Hospital Care Transition Program, which supports Rhode Islanders who may be good candidates to discharge from the hospital back to their homes or other community settings, but need a little extra assistance to make that possible. The CHW will be a critical part of a comprehensive team providing options counseling, resources and referrals for post-hospital care. CHWs will engage with consumers in hospital settings providing person centered, culturally sensitive support, and building on the values, strengths and preferences of the patient. The CHW will also serve as an effective role model and mentor.

Essential Functions:

• Assist patients and families in understanding and accessing informal and formal options for post-discharge care benefits including copay and cost of care.
• Review and educate on benefits and eligibility for Medicaid Fee-For-Service, Medicaid/Medicare Managed Care, Medicare Advantage Plans, and any available private insurances.
• Assist the consumer in completion and submission of enrollment or benefit applications.
• Refer consumers to other services and public or private agencies for additional supports as needed.
• Utilising motivational interviewing skills and culturally sensitive methods to collaborate with patients to explore preferred post-discharge supports and identify social determinants of health and/or areas of need within their community environment.
• Review care options including natural supports, home care services, medical equipment, adult day health programs, senior centers and assisted living communities.
• Coordinate with hospital discharge and health plan staff to enable post-discharge home and community supports to be established in a timely manner.
• Assist consumers as they transition to independence/case closure by engaging with consumers and providing follow up support.
• Maintain timely, accurate records, documentation, and reports as required.
• Actively participate and complete training and professional development activities.
• Assist in statewide system analysis, planning and coordination with state agencies, state and local boards, community-based organizations, and community rehabilitation programs.
• Accept other duties and responsibilities as assigned.

Qualifications Knowledge, Skills and Abilities:

• Ability to demonstrate sensitivity towards, relate to, form trusting connections with, and motivate consumers as a peer mentor and to address barriers to care, health and wellness.
• Knowledge of Rhode Island health systems, terminology, supports, and services.
• Demonstrated ability and skill to work collaboratively with co-workers, consumers, families, service providers, and health plans, etc.
• Skilled and/or willingness to learn and initiate motivational interviewing techniques with consumers.
• Demonstrated prior success in accessing community-based resources in Rhode Island.
• Strong written and oral communication skills.
• Excellent organizational skills to manage multiple priorities and tasks.
• A deep understanding of, commitment to, and ability to carry out the mission, vision, philosophy and values of RIPIN.
• Demonstrated proficiency with Microsoft Office/computer skills to enter data, prepare reports and correspondence.

Education and Experience:

• High School diploma or GED.
• Attained or working towards a bachelor’s degree, or a combination of education, experience, and skills to effectively carry out responsibilities and assignments.
• Community Health Workers certification preferred; non-certified incumbents are expected to earn certification within 18 months of hire date.
• Personal experience navigating state and community services and programs on behalf of self or a family member.
• Previous experience supporting families or individuals with special care needs or disabilities or families or individuals accessing health programs and services.
• Demonstrated ability to work both independently and as an effective team member.
• Demonstrated experience working with diverse populations.
• A combination of education and experience demonstrating acquisition of the skills and abilities required.

Physical Demands:

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. While performing the duties of this job, the employee is regularly required to climb stairs, reach, stretch, stand and bend. The employee frequently lifts and/or moves up to 25 pounds. Community Health Workers are required to climb up to three flights of stairs to conduct home and community visits.

Working Conditions/ Work Environment:

Primary work location is a climate-controlled indoor hospital or office environment; however, employee will also be required to conduct visits in private homes and various community locations. A significant portion of work may be based out of a hospital location, which may bring elevated risk of exposure to COVID-19 or other infectious diseases. Must have suitable space to work remotely at home as needed. Must be able to provide own reliable transportation to facilitate visits to client’s home or community setting and travel between multiple provider sites. Flexibility for occasional travel related to job requirements. Willingness and ability to work limited evenings and weekends as needed. Provide own reliable transportation with proof of RI minimum requirements of auto insurance. Will be required to follow site’s COVID testing and vaccination requirements. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

RIPIN provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, or status as a covered veteran in accordance with applicable federal, state and local laws.