LifeLong Medical Care

  • Community Health Worker – Care At Home

    Job Locations US-CA-Berkeley
    Posted Date 1 week ago(3/13/2019 10:42 PM)
  • Overview

    Community healthcare is highly rewarding and very attractive for the right medical professionals. Come join a dynamic care team at LifeLong Medical Care. We are looking for a Community Health Worker (CHW) for the Care At Home program. Care At Home (CAH) is a program for underserved senior patients who are medically homebound. The Care At Home Community Health Worker is a part of a multidisciplinary care team (including MDs, NPs, PAs, RNs, and LCSWs) focused on provision and coordination of care for CAH patients, including primary care, behavioral health, and social services. This is program originated from LifeLong’s Over Sixty Health Center and this position will be based at the LifeLong Ashby Health Center in Berkeley.


    The Community Health Worker must be able to provide direct care services to a diverse patient population. Ideally, the CAH CHW will be a trusted member of the community in which they will work. This relationship will enable the CHW to serve as a liaison between patients at home, health and social services, and the clinic. Some of this work will take place in patients’ homes during house calls. 


    This is a full time, benefit eligible position.


    LifeLong Medical Care is a large, multi-site, Federally Qualified Health Center (FQHC) with a rich history of providing innovative healthcare and social services to a wonderfully diverse patient community. Our patient-centered health home is a dynamic place to work, practice, and grow. We have 16 primary care health centers and deliver integrated services including psychosocial, referrals, chronic disease management, dental, health education, home visits, and much, much more.


    LifeLong is an Equal Opportunity Employer.



    We offer competitive salaries and excellent benefits including: medical, dental, vision (including dependent and domestic partner coverage), generous leave benefits including nine paid holidays, Flexible Spending Accounts, 403(b) retirement savings plan.


    • Primary point of contact for patients and caregivers; collaborate and coordinate medical needs/issues with treatment team.
    • Proactively identifies high-risk patients needing care at home; assists with panel management to identify patients in need of medical or behavioral health house call visits.
    • Calls new patients and assesses eligibility for CAH.
    • Conducts full support services assessments with new patients to determine needs.
    • Tracks CAH quality measures.
    • Collaborates with Home Meds program to review fall risk of patients with multiple medication prescriptions; enrolls all new patients in Chronic Care Management program.
    • Tracks client attendance and follows up on no-shows to support and improve continuity of treatment.
    • Schedules CAH visits for patients and communicates scheduling coordination to CAH team.
    • Tracks patients’ progress and alerts providers to need for enhanced services.
    • Provides case management services, including referrals to community resources, liaison with medical and mental health providers, troubleshooting around insurance, medication, or transportation issues.
    • Coordinates telemedicine visits by connecting patient to provider from patient’s home.
    • Contributes to building efficacious relationship among CAH teams by communicating information, responding to requests, and participating in team problem-solving methods.
    • Completes other tasks as assigned by supervisor/CAH providers.


    • Commitment to the provision of primary care services for the underserved with demonstrated ability and sensitivity in working with a variety of people from low-income populations, with diverse educational, lifestyle, ethnic, and cultural origins.
    • Ability to exercise sound judgment independently.
    • Ability to seek direction/approval on essential matters, yet work independently with little onsite supervision, using professional judgment and diplomacy.
    • Ability to work effectively and calmly while prioritizing multiple work demands.
    • Strong organizational, administrative, and problem-solving skills, and ability to be flexible and adaptive to change.
    • Excellent interpersonal, verbal, and written skills and ability effectively work with people from people from diverse backgrounds and be culturally sensitive.
    • Work in a team-oriented environment with a number of professionals with different work styles and support needs.
    • Be creative and mature with a “can do”, proactive attitude and an ability to continuously “scan” the environment, identifying and taking advantage of opportunities for improvement.

    Job Requirements

    • Bachelor’s degree in Social Work, Health or Human Services field, or equivalent combination of education and/or experience.
    • Reliable transportation to make home visits throughout Alameda and Contra Costa County.

    • Previous experience in health or social service setting.
    • Proficient in Microsoft office word with ability to manage databases.


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