Community Health Worker Manager

PRIMARY FUNCTION: The Community Health Worker Manager (CHW Manager) leads Malama I Ke Olas community health worker program and is accountable for how patients move between clinical care and community-based services. The position plans, implements, and evaluates CHW-delivered programs, including outreach, care navigation, social determinants of health (SDOH) support, and chronic disease self-management, within the Patient-Centered Medical Home (PCMH) model. The CHW Manager also leads the health centers response to changes in public benefit programs that affect patients health coverage and access to care. The current priority is implementing federal Medicaid changes under H.R. 1, enacted in 2025, including new community engagement (work) requirements, more frequent eligibility renewals, and eligibility changes for certain immigrant populations. The CHW Manager builds and executes the outreach plan for these changes, coordinates across clinical, eligibility, and community partners, and reports on results. This position requires strong community knowledge, sound planning, clear communication, and consistent follow-through. ESSENTIAL DUTIES AND FUNCTIONS A. Program Leadership & Planning Develop annual CHW program work plans with goals, timelines, staffing assignments, and measurable outcomes aligned with organizational priorities and grant requirements. Translate organizational and grant objectives into operational workflows, protocols, and CHW assignments. Monitor program performance against plan and adjust strategy, staffing, and tactics as needed. Contribute program content, data, and budget input to grant applications, reports, and funder communications. Represent the CHW program in management meetings and cross-department planning. B. Coverage Retention & Benefits Policy Response Current priority: H.R. 1 Medicaid changes. Lead the development and implementation of a written outreach plan to help patients keep health coverage through federal and state policy changes, including Medicaid community engagement requirements, six-month renewals, and eligibility changes affecting immigrant patients. Work with data and clinical teams to identify affected patient populations, prioritize outreach by risk and renewal date, and build contact lists and tracking tools. Translate policy changes into accurate, plain-language, culturally appropriate patient materials and scripts in multiple languages; ensure messaging is reviewed and approved before release. Coordinate with health center eligibility and enrollment staff, Med-QUEST, QUEST health plans, and community partners on renewal assistance, documentation support, exemption screening, and referrals. Train CHWs and front-line staff on policy changes, patient messaging, and referral pathways. Track outreach reach, patient outcomes (coverage retained, lost, reinstated), and emerging barriers; report results and recommend adjustments to leadership. Monitor policy developments and update the plan and materials as state implementation guidance changes. C. Patient Flow, Care Navigation & Closed-Loop Referrals Serve as the point of accountability for patient movement from identified need to completed service across clinical and community-based pathways. Ensure provider care plans are translated into clear, actionable CHW tasks. Ensure High-Needs Patients identified with medical providers are contacted before their next visit, and that pre-visit planning with RNs and providers is completed. Define, maintain, and monitor standards for closed-loop referrals (internal and external); resolve breakdowns in referrals, follow-up, and care coordination. Identify and resolve systemic barriers to patient access, escalating as needed. D. CHW Supervision & Team Development The CHW Manager directly supervises Community Health Workers. Set daily priorities, direct real-time response to urgent or high-risk situations, and ensure CHW activities align with active clinical care plans. Recruit, select, onboard, and train CHWs; conduct 1: 1 sessions and annual performance evaluations; address performance issues in partnership with the Programs Manager and Human Resources. Prepare and publish work schedules; approve timecards and time-off requests in compliance with pay policies. Ensure the team delivers direct services, including care coordination, SDOH navigation, patient education, appointment and no-show follow-up, transportation coordination, vital signs, interpretation as qualified, and supply inventory. Provide direct services as needed to maintain coverage. Build CHW skills through coaching, case review, and structured training. E. Community Partnerships & Outreach Build and maintain working relationships with community organizations, government agencies, health plans, and schools to strengthen referral pathways and outreach reach. Plan and oversee community outreach events and group health education; manage event capacity and staffing. Oversee development of outreach and education materials in multiple languages and formats. Represent Malama I Ke Ola at community meetings and coalitions as assigned. F. Data, Reporting & Quality Improvement Define and track CHW program metrics (e.g., outreach contacts, referral completion, coverage retention, care plan follow-through). Produce regular program reports for leadership and funders; ensure data accuracy and timely submission. Ensure staff time and activity documentation meets grant and federal requirements, including time-and-effort reporting for grant-funded positions. Identify recurring gaps in patient flow and care coordination; lead workflow improvements and standardized processes for SDOH screening, navigation, and follow-up. G. Compliance & Professional Practice Practice within the organizations Clinical Protocols, Guidelines, and Policies and Procedures. Ensure CHW team compliance with HIPAA, patient privacy, and grant requirements, with particular care for patients immigration-related and eligibility information. Participate in the clinics Emergency Preparedness Plan. Participate in management training and continuing education to maintain competencies. Model Malama I Ke Olas core values. QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential job function assigned satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education: High School Diploma or equivalent plus five years of relevant experience, including demonstrated program leadership preferred Experience: Three or more years in community health work, care coordination, patient navigation, or community outreach in a health or social services setting. Two or more years supervising staff. Demonstrated experience designing and carrying out a multi-part program or outreach plan with measurable results. Experience with Medicaid/Med-QUEST eligibility, enrollment, renewals, or benefits navigation strongly preferred. FQHC, PCMH, or community health center experience preferred. Experience working with Mauis communities, including Native Hawaiian, Pacific Islander, Filipino, Spanish-speaking, immigrant, and wildfire-affected populations, strongly preferred. Skills/Competencies: Builds workable plans: sets goals, sequences tasks, assigns owners, and meets deadlines. Translates complex policy and clinical information into plain language for patients, staff, and partners. Strong written and verbal communication, including presenting to groups and leadership. Proficient with Microsoft Office, especially spreadsheets; able to use EHR reports and tracking tools to manage a program. Leads and holds a team accountable while maintaining trust. Builds and sustains partnerships across organizations. Communicates in a trauma-informed, culturally responsive manner. Sound judgment in fast-changing situations; knows when to act and when to escalate. Written and oral fluency in English required. Languages spoken by the health centers patient populations strongly desired. Accurately take and record vital signs. Certifications: Valid drivers license. Access to an insured vehicle. TB clearance within the previous 12 months. BLS CPR certificate.