Assists and supports patients, families, community members, and health care providers with accessing and utilizing resources, information, education, and other supportive services related to Social Determinants of Health (SDoH).

1. Reaches out to patients identified by SDoH screenings and referrals.
2. Provides assistance in the identification and referral to resources for the health care team and patients/families. Meets with patient to assess the need for services. Consults, educates, and directs the health care team to clarify the need for services. Determines the availability of services required. Provides patient information and support concerning available resources. Assists patient in obtaining appropriate resources. Maintains expertise in resources for addressing SDoH needs.
3. Visits patients at home or community locations as needed.
4. Updates the Community Resource Directory, utilizes RedCap database for tracking of interactions and documents in EPIC EMR.
5. Implements evidence based curriculum as needed.
6. Identifies and contributes to the development of systems and resources needed to meet the support needs of patients/families and staff/institution.
7. Assists in marketing Community Health work and Social Determinants of Health impact to providers and system.
8. Performs other duties as required or assigned.

• Bachelor's degree in Human Service or related field preferred. High School diploma/GED with equivalent experience considered.



• Excellent interpersonal, communication, and organizational skills required.

• None