Description
Promote community and population health by providing psychosocial support, counseling, referrals, and care coordination to individuals, families, and groups affected by chronic, acute, or emerging health conditions. Connect people and communities to resources, advise caregivers, and lead outreach, prevention, and policy advocacy to reduce barriers to care, prevent disease, and advance health equity.
- • Collaborate with public health nurses, clinicians, and community partners to assess community and client needs.
- • Conduct outreach, home visits, and screenings to identify risks and connect people to services.
- • Provide individual and group counseling, facilitate support groups, and educate family caregivers.
- • Link clients and families to housing, food, transportation, legal aid, and financial assistance.
- • Design, implement, and evaluate prevention and health promotion programs.
- • Identify social determinants and environmental barriers through interviews, home visits, and record review.
- • Plan and coordinate care across public health, primary care, behavioral health, and social service systems.
- • Adjust service plans as client needs and circumstances change.
- • Monitor, document, and evaluate client and program outcomes using measurable goals.
- • Advocate for clients and communities to remove barriers and resolve crises.
- • Build and maintain partnerships with schools, faith groups, shelters, and community organizations.
- • Participate in policy development and community organizing to advance health equity.
- • Train and supervise community health workers, peer educators, or volunteers.
- • Collect and analyze data for needs assessments, program evaluation, and quality improvement.
- • Maintain accurate documentation and reporting in compliance with public health regulations, HIPAA, and mandated reporting laws.
- • Coordinate transitions between hospitals, clinics, and community-based supports.
- • Provide risk communication and crisis response during outbreaks, disasters, or other public health emergencies.
- • Ensure culturally and linguistically appropriate services and health education.
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Healthcare & Human Services
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Tasks & skills:
O*NET occupational data (work activities, skills, knowledge).
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Last reviewed: Jan 2026
