Maryland Primary Care Physicians

Community Health Worker

• Communicate program purposes and potential impacts to clients/patients
• Help patients identify socio-economic issues affecting their health and develop health/social management plans and goals
• Document client encounters and contacts; submit monthly reports; maintain comprehensive electronic client files
• Educate clients on proper Emergency Room use and alternatives
• Coach patients in chronic health condition management and self-care
• Assist clients with health-related services, medical homes, needed medical care, and social services
• Provide support and advocacy during initial medical visits and referrals
• Facilitate access to community resources such as housing, food, clothing, parenting resources, life-skills providers, and mental health services
• Assist with scheduling social-service appointments and completing program applications
• Facilitate communication and coordinate services between providers and clients/patients
• Coordinate and monitor services and track client compliance with care-plan objectives
• Build working relationships with clients, providers, nurse case managers, agency representatives, and office staff
• Reduce cultural and socio-economic barriers between clients and institutions
• Maintain confidentiality of member records
• Work in clinical and community-based settings, including clients’ homes

• Conduct intake interviews with members and complete Social Determinants of Health assessments
• Communicate the program’s purpose and potential impact on members’ well-being
• Help patients identify socioeconomic issues affecting health and develop health/social management plans and goals
• Partner with community organizations, governmental agencies, and local resources
• Assist patients in understanding care plans and instructions
• Help members access health-related services and overcome barriers to medical care and social services
• Schedule appointments with social services agencies and assist with program applications
• Provide support and advocacy during medical visits when necessary
• Follow up with members and providers regarding health/social services
• Maintain positive working relationships with members, providers, nurse case managers, agency representatives, and office staff
• Work to reduce cultural and socioeconomic barriers between members and institutions
• Maintain confidentiality of member records

Community Health Worker – SDoH

• Conduct intake interviews and complete Social Determinants of Health assessments
• Explain the program and its impact on clients' well-being
• Help patients identify socioeconomic issues affecting health and develop health/social management plans and goals
• Assist clients in accessing social services and addressing barriers to care
• Partner with community organizations, governmental agencies, and local resources
• Document client encounters, activities, service plans, and outcomes
• Complete and submit monthly reports and maintain comprehensive electronic client files
• Assist patients in understanding care plans and instructions
• Provide support and advocacy during medical visits and referrals
• Assist clients with community services, appointment scheduling, and program applications
• Build positive working relationships with clients, providers, nurse case managers, agency representatives, and office staff
• Reduce cultural and socioeconomic barriers between clients and institutions
• Maintain confidentiality of member records according to MPC policies and procedures
• Work in clinical and community-based settings, including client homes

Community Health Worker

Community Health Worker – SDoH

Community Health Worker, SDoH