UNC Heeling Bridge Program Community Health WorkerYour passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina. The UNC Heeling Bridge Program Community Health Worker works principally with persons experiencing homelessness or housing instability and other individuals living with chronic and acute illnesses, mental health challenges, substance use disorders, and significant social needs who reside in Orange County. The CHW will work closely with medical providers, medical learners, nurses, behavioral health clinicians, and public health/social service personnel as part of a multidisciplinary Street Medicine team, including regular attendance at the UNC Family Medicine Drop-In Clinic at the Inter-Faith Council for Social Service (IFC) and other local health care service providers where Heeling Bridge patients receive care, as well as regular street outreach with the Orange County Street Outreach and Harm Reduction and Deflection Program's outreach team. The CHW will outreach and engage with individuals using a trauma-informed approach to facilitate access to care, care coordination, health education, advocacy, and connection to resources.
Hours:
40-hour work week schedule (weekly hours may vary to facilitate occasional evening outreach to shelters during cold weather emergency housing periods when temperature is below 32 degrees).
Responsibilities
Outreach, Engagement, and Trust-Building:
Conduct outreach and engagement with individuals experiencing homelessness or housing instability in community-based settings, including encampments, shelters, drop-in spaces, and other locations where people gather. Build supportive, respectful, and trusting relationships with individuals who may be hesitant or mistrustful of healthcare systems. Communicate the purpose of Street Medicine and CHW services and support patient-centered goal setting related to health, housing, and stability.
Care Coordination and Navigation:- Assist individuals in accessing health-related services, including establishing a medical home, primary care, specialty care, behavioral health services, substance use treatment, and social services.
- Provide care coordination and follow-up to ensure continuity of care across medical, behavioral health, and community-based systems, including regular participation in care team meetings.
- Advocate for patients during medical or social service encounters and assist with appointment scheduling, referrals, and transportation coordination as needed.
- Chronic Disease, Infectious Disease, and Mental Health Support
- Support individuals with chronic medical conditions by promoting self-management, preventive care, and adherence to treatment plans.
- Assist individuals living with or at risk for HIV, HCV, and other infectious diseases in accessing testing, treatment, and ongoing care.
- Conduct informal assessments related to physical health, mental health, substance use, and social determinants of health.
- Facilitate connections to mental health services, substance use treatment, and supportive counseling resources.
Health Education and Empowerment:
Educate individuals on evidence-based standards of care, appropriate use of urgent and emergency services, and alternatives for routine care.
Coach individuals in understanding their care plans, medications, and follow-up instructions.
Encourage active participation in healthcare decision-making and self-advocacy.
Community Resource Connection:
Maintain current knowledge of community resources related to housing, food, clothing, transportation, benefits, and social supports.
Assist individuals with completing applications and navigating systems required to access public benefits and community services.
Help individuals overcome social, structural, and logistical barriers to accessing care and basic needs.
Documentation, Data, and Quality Improvement:
Document all outreach activities, patient encounters, service plans, referrals, and outcomes in accordance with program and organizational policies.
Maintain accurate and up-to-date electronic records, including assessments, notes, and releases of information.
Assist with data collection, reporting requirements, and quality improvement activities related to grant-funded programs.
Team Collaboration and Program Support:
Work collaboratively as part of a multidisciplinary Street Medicine team.
Communicate regularly with providers, behavioral health staff, case managers, supervisors, and community partners.
Participate in team meetings, trainings, outreach events, and ongoing professional development opportunities.
Provide feedback and insight from field-based work to inform program development and improvement.
Other Responsibilities:
Travel within the community to support outreach, engagement, and care coordination activities. Perform additional job-related duties as assigned to support program operations. Preferences: Lived experience with homelessness, housing instability, or healthcare system navigation (strongly valued).Community Health Worker certification or similar credentials (e.g., peer support).Experience working in street medicine, homeless services, behavioral health, and/or safety-net healthcare settings. Experience collaborating within multidisciplinary healthcare or public health teams. Experience with electronic health records, case management systems, or grant-funded program reporting.
