ECM COMMUNITY HEALTH WORKER

ECM COMMUNITY HEALTH WORKER JOB SUMMARY

The Enhanced Care Management (ECM) Community Health Worker (CHW) plays a vital role in supporting patients with complex medical, behavioral health, and social needs. The CHW serves as a trusted member of the care team, providing outreach, engagement, and navigation support to help patients access healthcare and community resources. The CHW works closely with case managers, providers, and community partners to reduce barriers, improve health outcomes, and empower patients to actively participate in their care.

ECM COMMUNITY HEALTH WORKER ESSENTIAL DUTIES AND RESPONSIBILITIES

• Conduct outreach to patients eligible for ECM services through phone calls, home visits, and community-based engagement.
• Build trusting relationships with patients, their families, and caregivers to support care plan goals.
• Assist patients in navigating healthcare systems, including scheduling appointments, transportation coordination, and accessing primary/behavioral health services.
• Identify and connect patients to community resources, including housing, food, financial assistance, and social support services.
• Support care managers by reinforcing care plans, helping patients follow through on goals, and addressing day-to-day challenges.
• Provide culturally appropriate health education and encourage self-advocacy in care decisions.
• Document outreach activities, resource connections, and patient progress in the electronic health record (EHR) and program tracking tools.
• Participate in interdisciplinary case conferences and care team meetings.
• Advocate for patients by helping them overcome barriers to care and promoting equitable access to services.
• Maintain confidentiality and comply with HIPAA and organizational policies.