Peer Worker - Part-Time Temporary Role - Ryan Chelsea Clinton

February 10, 2020

Position Overview:

Under the direction of the Community Relations Coordinator, in conjunction with the Deputy Director and Site Medical Director, the Peer Worker provides care coordination, health education, and health promotion services to address barriers to care and to ensure that residents in need of care at the Chelsea-Elliot Housing communities are all identified and services provided. This work is carried out in support of the mission and goals of Ryan Chelsea-Clinton.

Essential Functions:

Care Coordination

1. Assesses patients for patient navigation/care management services.

2. Develops, implements, monitors, and reassesses comprehensive care plans to address barriers and expected health outcomes and self-management goals, incorporating, as clinically appropriate, the role of medical practitioners, behavioral health providers, and other community providers.

3. Collaborates and consults with the patient’s care team, including both Ryan and non-Ryan providers, in identifying service gaps as a part of care planning, case disposition, and case closure.

4. Schedules patient appointments with Ryan providers and, as necessary, provides referrals and appointment follow-up with non-Ryan service and medical providers.

5. Informs residents of relevant benefits and entitlement programs and health insurance programs through the New York State of Health Marketplace.

Outreach and Enrollment

6. Conducts intensive outreach to residents that have disengaged or are at risk of disengaging from care, and individuals whose psychosocial stressors are limiting their success in achieving healthy outcomes, and who can benefit from patient navigation and connections to services offered at Ryan locations.

7. Provides home, hospital, or community site visits and escorts patients to medical and non-medical appointments, as indicated in the patient’s care plan and as approved by the Site Medical Director.

8. Develops linkages between community agencies and resources to ensure continuity of care.

Documentation & Quality Assurance

10. Ensures completion of mandated assessments within specified time periods according to regulatory bodies, including the New York State Department of Health.

11. Maintains patient records in accordance with agency protocols and standards using Ryan’s electronic medical record system, as well as care management systems used between Ryan and the State of New York.

12. Participates in Quality Improvement/Performance Improvement (QI/PI) teams, for the purpose of identifying, planning, implementing, and evaluating QI/PI initiatives.

Policies, Procedures, & Compliance

13. Attends required meetings, case conferences, supervision, trainings, Ryan events, and professional conferences as assigned.

14. Immediately reports any problems or unusual occurrences to the Community Relations Coordinator, Deputy Director, or appropriate site administrator.

15. Special projects and other duties as assigned.


Minimum Experience and Skills Required:

  • 2 years of relevant experience working with a population with chronic conditions in a medical setting.

  • Effective communication and writing skills.

  • Strong organizational skills and attention to detail.

  • Strong skills in Microsoft Word, Excel, and Outlook.

Education, Licenses and/or Certifications Required:

  • Bachelor’s degree in Social Work or related field.

    Preferred Qualifications:

  • Bilingual Spanish/English.


  • Works well with others

  • Contributes input to improve outcomes

  • Asks others for opinions and feedback, provides feedback in a tactful respectful way

Minimal Training Time:

90-day probationary period.

Working Conditions:

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit, talk and hear.

The employee is occasionally required to move about the office; use hands and fingers to feel, handle, or operate office equipment.

Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment

The work is primarily in a mental health clinic and/or general primary care setting which includes the unpredictability in behaviors of individuals and acute and chronic infectious diseases which may be contagious. Adequate preparation and precaution is necessary.


The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position. This position may be required to perform other duties. If such work becomes a permanent and regular part of the job, a new description will be prepared.

Equal Opportunity Employer

Ryan Health Community Health Center is an Equal Opportunity / Affirmative Action Employer and does not discriminate because of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sexual orientation, gender identity, military veteran status, or any other characteristic protected by law. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.

How To Apply