Duke Connected Care, a community-based, physician-led network, includes a group of doctors, hospitals and other healthcare providers who work together to deliver high-quality care to Medicare Fee-for-Service patients in Durham and itssurrounding areas.

General Description

The Population Health Resource Associate- Community Health Worker is responsible for the implementation and care coordination of comprehensive patient plans which support patient’s recovery and management of their chronic health conditions. This position will act as a liaison between patients and important community partners and resources to ensure continuity of care. As a Community Health Worker, this position will assist patients and caregivers in navigating community resources to reduce barriers to care and improve health outcomes. This role may see patients in settings including but not limited to patient’s home, medical clinic and community.

Duties and Responsibilities of this Level

Provide outreach and care management support to patients

Educate clients of available community resources

Ability to manage an active caseload while balancing multiple tasks

Review and update person centered care plans to measure progress and patient outcomes

Ability to act as a collaborating member of a multi-disciplinary team

Complete required documentation within the expected program timeframe

Ability to successfully navigate electronic medical records and document according to agency standards

Ability to meet productivity and performance expectations

Minimum Qualifications

Education

High school degree or equivalent, as well as strong communications and organizational skills.

Experience

Work generally requires customer service experience through patient or public contact. Two years of experience with customer interactions via phone and marketing/communications preferred. Active user of electronic medical records software strongly preferred. An associate’s degree or higher may be substituted for experience.

Degrees, Licensures, Certifications

NA

**North Carolina Integrated Care for Kids (NC InCK) a new model led by a partnership among Duke University, UNC Health, and the NC Department of Health and Human Services launched in January 2022 for children who are insured by Medicaid or CHIP (NC Health Choice) in Alamance, Orange, Durham, Granville, and Vance counties. A coalition of partners — including families, local organizations, and state leaders in the health, social, and educational needs of children — spent more than two years designing the model.

The NC InCK model (pronounced “ink”) supports integrated care for children by more holistically understanding their needs, supporting and bridging services for children and their families, and investing in what matters most to them. NC InCK builds on Medicaid’s whole-person Advanced Medical Home (AMH) care management model and practice-based incentive programs. NC InCK is bringing in additional data from schools and juvenile justice to supplement existing medical and behavioral health data to better identify children who could benefit from additional care management supports. These children and families will have the chance to work with a family navigator from their AMH or their Medicaid health plan. **

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.