Provide support to patients who are difficult to engage and/or who have cultural or linguistic barriers to care via field-based contacts including accompaniment to appointments
Assist the Registered Nurse Care Manager, Behavioral Health Care Manager and Care Coordinator in panel management by performing delegated activities as assigned
Assist the Enhanced Care Management (ECM) team in engagement efforts of eligible patients in the clinic and within the community
Assist patients on navigating the healthcare system and community resources
Perform follow-ups by phone and in person with all eligible and enrolled ECM patients
Help patients successfully participate in medical and/or behavioral health care and overcome barriers to care
Update and provide information on patient barriers to the multi-disciplinary team and providers
Engage with patients, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as motivational interviewing) and promotes collaboration between the patient and the medical/behavioral team
Collaborate on patient care plans with ECM team members
Participate in weekly systematic and ad hoc case reviews
Consult with the RN Care Manager and/or the Behavioral Health Care Manager before taking any action that is clinical in nature
Accompany patients to office visits, as needed, and in the most accessible setting, within health plan guidelines
Perform other duties and projects as assigned

Diploma/GED required , associate degree preferred
Minimum 1+ years of experience in healthcare, social services, or care coordination
Current and valid Driver’s License with a clean driving record
Reliable transportation and proof of auto insurance
Current BLS certification from the American Heart Association upon start date
Distraction-free home workspace with a secure internet connection
eClinicalWorks (eCW) experience (nice to have)
Care management experience (nice to have)

Make an impact: an organization who cares about its employees, communities, and the future of healthcare
Inclusivity: be a part of a workplace where you not only belong but also can be the best version of yourself
Growth: opportunities to develop and grow your career with us
Community: you are encouraged to have a voice, share your opinions, and have an individual impact on the business
Paid Time Off: 12 holidays and up to 15 days of accrued PTO to rest and recharge plus additional time for sick, jury duty, bereavement, reproductive loss, and therapy
Work Life Balance: enjoy flexibility to maximize your well-being and success with our hybrid work model
Medical, Dental, & Vision Benefits: we cover up to 100% of your premium and 50% of your dependents depending on the plan
Prioritize your mental health with unlimited therapy sessions funded 100% by Titanium Healthcare
Flexible Spending, Health Savings & Dependent Care Accounts
Life/AD&D insurance funded 100% by Titanium Healthcare
Supplemental Short-Term Disability
Employee Assistance Programs
Protect your pet(s) with Pet Insurance
401(k) plan

Bilingual Community Health Worker

Key skills