The Community Health Worker (CHW) serves as an essential member of the JCOD Care Management team and supports justice-involved individuals transitioning from incarceration into stable community living. Through a housing-first, trauma-informed, and person-centered approach, the CHW engages participants in supportive services that promote health, housing stability, successful reentry, community integration, and long-term self-sufficiency.
The CHW functions as a trusted liaison between participants, healthcare systems, behavioral health providers, housing resources, benefits systems, and community-based organizations. This position provides direct participant engagement, care coordination support, health promotion, advocacy, resource linkage, and field-based case management activities aligned with SCHARP’s supportive services model and departmental performance standards.
Essential Duties and Responsibilities
Participant Engagement & Reentry Support
- Conduct outreach, engagement, and participant enrollment activities for individuals returning to the community following incarceration.
- Establish therapeutic and professional helping relationships that promote trust, participant empowerment, and sustained engagement.
- Complete intake activities and assist participants with understanding program expectations and available supportive services.
- Support participant transition planning and continuity of care following release.
Care Management & Service Coordination
- Collaborate with Care Managers and interdisciplinary teams to implement individualized care plans and participant-driven goals.
- Support participant navigation across healthcare, behavioral health, housing, employment, education, and public benefits systems.
- Coordinate referrals and follow-up for medical, mental health, substance use treatment, and specialty services.
- Monitor participant progress and identify barriers to engagement, service access, and retention.
Health Promotion & Wellness Support
- Provide health education and coaching that supports participants’ ability to manage health conditions and make informed lifestyle decisions.
- Promote preventive healthcare utilization including primary care appointments, medication adherence, and wellness practices.
- Utilize motivational interviewing and strengths-based engagement strategies to support participant self-management and behavior change.
- Support participants in addressing social determinants of health impacting stability and well-being.
Housing Stability & Community Reintegration
- Assist participants in securing and maintaining stable housing placements.
- Conduct home visits and community-based visits to assess participant adjustment, environmental concerns, and supportive service needs.
- Support life skills development including budgeting, transportation planning, appointment management, and independent living skills.
- Collaborate with housing and property management partners to address barriers impacting tenancy success.
Documentation, Compliance & Quality Assurance
- Maintain timely, accurate, and complete participant documentation in agency-designated systems.
- Complete case notes, participant contacts, care coordination activities, and required program documentation within established timelines.
- Participate in chart audits, quality assurance reviews, and program reporting requirements.
- Maintain compliance with confidentiality standards, HIPAA requirements, and agency policies.
Team Collaboration & Program Participation
- Participate in case conferencing, interdisciplinary team meetings, supervision, and training activities.
- Collaborate with internal departments and external community partners to strengthen participant outcomes.
- Contribute to program performance goals related to participant engagement, retention, housing stability, and service utilization.
- Support departmental initiatives and continuous quality improvement efforts.
Qualifications
- High School Diploma or equivalent required.
- Associate’s or Bachelor’s degree in Social Work, Human Services, Public Health, Psychology, Sociology, Criminal Justice, or related field preferred.
- Community Health Worker certification preferred (or ability to obtain within required timeframe).
- Minimum one (1) year of experience working with reentry populations, homelessness services, supportive housing, healthcare navigation, behavioral health, or community-based services preferred.
- Experience conducting field-based outreach and participant engagement strongly preferred.
- Knowledge of trauma-informed care, Housing First principles, motivational interviewing, and care coordination practices preferred.
Knowledge, Skills, and Abilities
- Strong participant engagement and relationship-building skills.
- Ability to work effectively with justice-involved and high-acuity populations.
- Understanding of community resources, public benefits systems, and care navigation practices.
- Effective documentation, organization, and time management skills.
- Ability to maintain professional boundaries while providing compassionate support.
- Strong verbal and written communication skills.
- Ability to work independently and collaboratively in a multidisciplinary environment.