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University of Rochester Health Project Counselor - 223476 in Rochester, New York

Health Project Counselor Job ID 223476

Location Strong Memorial Hospital Full/Part Time Full-Time Favorite Job Regular/Temporary Regular Opening

Full Time 40 hours Grade 007 Social Work Division SMH


Position Summary:

The community health worker provides tracking, and outreach services to Emergency Department patients who are identified as uninsured, no utilization of primary care or low utilization of primary care in order to encourage their linkage with a primary care physician/practitioner, gain enrollment in health insurance, support patient confidence in understanding and self- management of personal health condition(s), improve provider to provider communication and provide supportive assistance to accessing appropriate care. Hours may include days, evenings, weekends and overnights.

Specific responsibilities:

Clinical Services:

  • Utilizing evidence based, patient activation activities identify patients in need of community health worker services. Engage assigned patients in identifying and resolving barriers to primary and preventive services and self - management of their health such as lack of insurance, no primary care provider, lack of transportation, knowledge deficit, low motivation,, competing priorities etc. preventing these patients from improving and managing their health.. Contact will be made in the ED, by phone, at primary care offices and through home visitation.

  • Provide level of intervention required to resolve barriers including ;

  • Connecting uninsured patients to Financial Case Management or Facilitated Enrollers

  • Helping patients to enroll with a primary care, provider.

  • Assisting with scheduling appointments for primary, specialty and behavioral health and completing appointment reminders.

  • Helping patients access needed resources such as medications , medical supplies as well as basic needs of housing, food, clothing , and heat

  • Identifying high risk psychosocial situations and refer to ED social work or PCP for management

  • Arranging for transportation or directly transporting if needed and appropriate.

  • Accompanying patients if needed to appointments, offering support and reinforcing self- management skills

  • Complete and document survey tools required for determining patient engagement measures.

Follow up on assigned patients to determine whether they received the needed care from PCP or other indicated provider and, if not, provide additional outreach services until linkage with PCP or other indicated provider is made.

Educate patients regarding how and where to access health care services including the role of the Primary Care Provider, urgent care and emergency department. Refer to Health Home Care Manager as needed.

Provide patients with assistance in gaining access to transportation for preventive appointments including directly transp01iing patients ifnecessary to appointments

Collaborate with providers in the Emergency Departments and the primary care sites to identify patient specific and practice level strategies for improving appropriate use of the Emergency Department. Educate provider staff regarding any patient cultural values or other beliefs that cause over use of Emergency Departments or other aspects of preventive care. Respond to provider requests for assistance with patient non- compliance or other interventions that improve compliance rates and integrate with the efforts of the interdisciplinary care team.

Collaborate with patient consent with community service providers involved with the patient's care including Health Home Care Managers, PCN Care Managers, home visiting programs , and visiting nurses Document all interventions in the electronic medical record.Provide opportunities for staff to shadow during home visits in order to expand their understanding of social/cultural/environmental barriers for the patient population. Other duties as assigned.


  • Complete reports and other data analysis to determine effectiveness of intervention on appropriate use of Emergency Department. Perform other administrative tasks specific to NYS requirements.

  • Maintain competence in the community resources available, use of the electronic record and policies and procedures governing the area of practice.

  • Participate in practice and project staff meetings, mandated hospital training, and Social Work Division In -service Training.

  • Report time worked utilizing the University time keeping system.

Professional Accountability, Supervision and Evaluation:

  • The Community Health Worker will be accountable to the Social Work Division for provision of project services and responsibilities. The Social Work Division will provide supervision and clinical consultation as needed to the Community Health Worker with focus on complex psychosocial problems preventing patients' access to care. The Community Health Worker will adhere to standards, policies, procedures and quality assurance practices of the Social Work Division. Included in the Social Work Division Policy is the requirement to report all reasonable suspicions of child abuse or neglect. The Social Work Division will consult with the Project Director regarding issues of the Community Health Worker's job performance. An initial competency assessment and annual evaluation will be completed by the Social Work Division with input from the interdisciplinary team.

    Position Qualifications:

The Community Health Worker must as a minimum have a high school diploma. An AAS degree and/or experience in a service-related field are preferred. In addition, the Community Health Worker must demonstrate good interpersonal skills as well as verbal, and written, communication skills, capacity to use Microsoft Office Word and Excell data bases, strong organizational skills, capacity to operate with significant independence, self-motivation, empathy, ,acceptance of and interest in a diverse client population, ability to respond supportively and with persistence to the client families and show understanding of the community, and ability to maintain project records. The ability to work well and flexibly with a variety of individuals is needed. Willingness to work within the community, complete home visits and directly transport clients is further required. Fluency in Spanish is helpful.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled