Community Weaver

FLSA Status

Non-Exempt

Job Role Summary

Under the general direction of the Health Center Manager the Community Weaver in collaboration with each health center’s Social Work, Community Health, primary care and mental health clinical teams and the Social Determinants of Health (SDOH) team, will act as a welcoming central point of contact for patients and their families seeking additional information or resources that are available at Eskenazi or in the community. This role supports Eskenazi Health’s engagement and partnership with the community surrounding the health center aligning with the mission, vision and values of Eskenazi Health (EH) and strategic plans of EH and EHC. The Community Weaver provides the ultimate in customer service, connecting the patient to Eskenazi programs, helping to navigate between departments, and providing specialized service to address the unique needs of the patient. The Community Weaver connects the community and patients to Eskenazi programs, helping to navigate between departments, and providing specialized service to address the unique needs of the patient. The Community Weaver will proactively contribute to Eskenazi Health Mission: Advocate, Care, Teach and Serve by connecting staff and community to each other in mutually beneficial ways.

Essential Functions and Responsibilities

• Act as bridging social capital to expedite community connectedness for patient by providing a warm handoff to a trusted community based organization with follow-up. 
• Connect residents to a medical home. 
• Works closely with Social Workers and Community Health Workers, with the goal of accelerating community knowledge and connectivity for the team. 
• Supports staff leadership as they participate in neighborhood leadership activities.  
• Other duties as assigned
• Perform home visits to patients to provide support, encouragement and guidance.
• Accurately documents home/telephone visit outcomes in a timely manner
• Develop supportive and therapeutic relationships with patients and their families
• Recommends community resources for patients order to meet the basic five needs of : housing, food, clothing, transportation and utilities Carries a caseload of at least 40-50 patients
• Monitors patient progress and reflects this in documentation during follow-up visits
• Demonstrates commitment to professional growth by actively participating in clinical supervision
• Works closely with Social Workers and Community Health Workers, with the goal of accelerating community knowledge and connectivity for the team
• Supports staff leadership as they participate in neighborhood leadership activities. 
• Other duties as assigned

Job Requirements

• High school diploma or GED with 3 years of community related experience
• Associate’s degree preferred
• Community Health Worker certification preferred
• Valid Indiana driver's license that meets Eskenazi Health's driving policy requirements
• Flexible hours, sometimes working on weeknights and weekends

Knowledge, Skills & Abilities

• Ability to relate to a variety of people within different cultures, socioeconomic backgrounds and education levels
• Ability to establish and maintain effective working relationships with superiors, coworkers, patients and families
• Willingness to work with patients and their family members or other support persons in the clinic, hospital, home, and community settings
• Basic computer skills with proficiency in Microsoft applications
• Strong interpersonal skills; ability to be both clear and concise in written and verbal communication