Community Health Worker, Patient Engagement

Who We Are
Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity.
The primary location for this role is remote in Southern New Jersey but will entail frequent travel throughout the area.
What You’ll Do
As part of the Patient Engagement Team, this role supports patients in re-engaging with Imagine Pediatrics services, ensuring they receive appropriate support by meeting them where they are. The role partners with an interdisciplinary team to address patient needs and enhance re-engagement of patients who were previously enrolled but did not complete onboarding or have not actively utilized services, ensuring they are supported in reconnecting with Imagine Pediatrics care. You will:
Serve as a community-based, patient-facing resource, building relationships with patients and caregivers through direct, in-person re-engagement in assigned geographic areas
Provide hands-on support to patients and caregivers, including assisting with program re-enrollment, onboarding, and mobile app setup and utilization
Preform telephonic outreach to caregivers of attributed patients to re-engage children in care, support seamless onboarding, and re-engage those who missed their initial onboarding visit or have not utilized services post-onboarding
Educate patients and caregivers on Imagine Pediatric services and available community resources, ensuring they understand how to access care and support
Maintain and gather up-to-date knowledge of local community resources (e.g., social services, healthcare providers, SDOH supports) and connect families to appropriate services
Conduct community events and facility rounding to engage eligible patients, strengthen relationships, and support ongoing program participation
Partner with our Behavioral Health teams and local behavioral health providers to support safe patient discharge planning and ensure seamless connection to community-based resources and ongoing care.
Partner with caregivers, families, and facility staff to identify and address barriers to engagement, and access to care and work with leadership on ensuring workflows exist to enable access to care
Collaborate closely with the Patient Engagement Team (Outreach & Enrollment), including Outreach Specialists and Registered Nurses, to support patient re-engagement goals
Support non-clinical care coordination efforts in the community, including assisting with:
Connecting patients to primary care providers
Facilitating pharmacy access and medication-related needs
Providing basic discharge and follow-up support
Addressing social determinants of health (SDOH) needs