Community Health Worker at EPIC Health System LLC – Detroit, Michigan

Organization: EPIC Health
Schedule: Full-Time (40 hours/week)
Location: Detroit, MI

At EPIC Health, we do not treat Social Determinants of Health as “adjacent” to care—we treat them as core drivers of outcomes.

The Community Health Worker (CHW) plays a critical frontline role in operationalizing EPIC Health’s Model of Care. This position exists to address real-world barriers, reinforce Provider-Derived Care Management (PDCM), and ensure patients can access, understand, and follow through on their care plans.

This is not a passive referral role. This is action-oriented, community-embedded work that directly impacts patient outcomes.

We are seeking a licensed, credentialed Community Health Worker who is committed to improving access, strengthening trust, and helping vulnerable populations navigate complex healthcare and social systems.

• Serve as a trusted and consistent point of contact for patients navigating healthcare, social services, and community systems.

• Act as a bridge between patients, families, caregivers, providers, and community-based organizations.

• Identify and remove barriers preventing patients from engaging in care or achieving care plan goals.

• Conduct proactive outreach (in-person and phone) based on patient risk level, provider direction, and care team priorities.

• Partner closely with Medical Social Workers and providers to support individualized care plans.

• Reinforce Provider-Derived Care Management by supporting goal-setting, coordination, and follow-through.

• Ensure care plans translate into action—not just documentation.

• Maintain an active, up-to-date working inventory of local resources, including:

  • Housing

  • Food access

  • Transportation

  • Utilities

  • Benefits enrollment

  • Activities of Daily Living (ADLs)

  • Social supports

• Connect patients with appropriate state and local programs and assist with applications and documentation.

• Deliver culturally appropriate health education within EPIC-approved training and competency guidelines.

• Engage patients in EPIC Health centers, homes, community settings, and external provider facilities.

• Spend approximately 50% of your time outside the health center supporting patients in real-world environments.

• Accompany high-risk patients to appointments when needed to improve adherence and continuity of care.

• Participate in interdisciplinary care team meetings.

• Provide community-level insight to inform clinical decision-making.

• Facilitate communication between patients, providers, and support systems.

• Document all patient interactions accurately and timely in the electronic medical record.

• Maintain strict HIPAA compliance.

• Manage your time independently with strong accountability.

• Patients trust you and actively engage in their care.

• Social and access barriers are resolved—not merely identified.

• Care plans convert into completed visits, improved adherence, and measurable outcomes.

• Providers rely on you as the expert on patient reality and community context.

• Active Community Health Worker (CHW) Certification.

• Minimum of 1 year of experience in healthcare, community-based work, case management, or social services.

• Strong verbal and written communication skills.

• Ability to manage multiple priorities with a solutions-oriented mindset.

• Demonstrated commitment to serving diverse and vulnerable communities.

• Proficiency with basic computer systems (Windows, Google Workspace, Microsoft Office).

• Reliable transportation and ability to travel throughout the community.

• Authorization to work in the United States.

• Bilingual or multilingual (commonly English/Spanish, depending on community need).

• Experience working on interdisciplinary or multidisciplinary care teams.

• Deep familiarity with local community resources and navigation systems.

At EPIC Health, we are committed to transforming healthcare for vulnerable populations by addressing both medical and social drivers of health.

Our integrated care model combines primary care, specialty services, behavioral health, and care management under one coordinated system. Community Health Workers are not peripheral—they are central to how we improve outcomes and reduce avoidable utilization.

Here, your work directly impacts access, equity, and long-term health stability for the communities we serve.

• Competitive, market-aligned compensation.

• Comprehensive benefits package (Health, Vision, Dental, Disability, Life Insurance).

• 401(k) retirement plan.

• Paid Time Off and Holiday Pay.

• Ongoing professional development and training.

• A supportive, mission-driven team environment.

• Opportunities for growth within an expanding, integrated healthcare organization.

If you are ready to be a hands-on advocate and make measurable impact in your community, we invite you to apply and join EPIC Health.

Background check required for this role.