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Join the HUM Team

Moms Under Pressure
Care Coordinators

Moms Under Pressure Care Coordinators: (2 Positions 10-15 hours a week)- CHW

Location: Travel + Remote + 1-2 days a week at The Haven

Organization: Huddle Up Moms

Summary:  Moms Under Pressure is funded by grants provided by the CDC to the Virginia Department of Health. The CDC awarded VDH two multi-million-dollar grants to address heart disease in the Commonwealth, named the CDC National Cardiovascular Health Program and the Innovative Cardiovascular Health Program. The two grants established the Virginia Cardiovascular Health Program, implemented and managed by the Office of Family Health – Division of Prevention and Health Promotion. The Virginia Cardiovascular Health Program has united state and local partners--including Huddle Up Moms--to implement and evaluate CDC evidence-based strategies to improve blood pressure control, reduce disparities in cardiovascular disease, and connect communities at high risk for heart disease and stroke to clinical and social services.​


Huddle Up Moms (HUM) is seeking two dedicated Clinical Care Coordinators to join our Cardiovascular Health Program team. The Clinical Care Coordinators will play a vital role in engaging pregnant individuals in the community, providing support, education, and care coordination throughout their pregnancy. These positions will serve as the frontline workers in the program, focusing on registration, enrollment, blood pressure monitoring education, community engagement, and ongoing support for program participants.



  1. Engagement and Enrollment:

    1. Identify and engage pregnant individuals in the community who are eligible for the Cardiovascular Health Program.

    2.  Conduct outreach and recruitment activities to promote program enrollment and participation.

    3. Assist individuals with program registration, enrollment forms, and consent processes.

  2. Care Coordination:

    1.  Serve as the primary point of contact for program participants, providing ongoing support and guidance throughout their pregnancy

    2. Conduct initial assessments and develop individualized care plans based on participant needs and program objectives.

    3. Coordinate with healthcare providers, community resources, and support services to ensure comprehensive care for program participants.

    4. Goal is to enroll 75 mothers locally for each program coordinator in Southwest Virginia

  3. Blood Pressure Monitoring Education:

    1. Provide training and education to program participants on how to use blood pressure cuffs for self-monitoring.

    2. Help participants understand the importance of regular blood pressure monitoring and how to communicate their readings to their healthcare team.

  4. Community Engagement:

    1. Build and maintain relationships with community partners, healthcare providers, and other stakeholders to promote program awareness and engagement.

    2. Collaborate with community organizations to host educational opportunities, workshops, and events for pregnant individuals and community members.

  5. Ongoing Support and Follow-up:

    1. Conduct regular check-ins with program participants to assess their progress, address any concerns or questions, and provide ongoing support.

    2. Offer guidance and resources to participants to help them navigate challenges related to pregnancy, health, and social determinants of health.

  6. Program Implementation and Evaluation:

    1. Assist with the implementation of program activities and initiatives, following program protocols and guidelines

    2. Collect data and documentation related to participant interactions, program activities, and outcomes for program evaluation and reporting purposes.



  • Associate's or Bachelor's degree in nursing, public health, social work, or related field.  Community Health Worker experience is a plus.

  • Previous experience in community health, maternal health, or care coordination preferred.

  • Strong interpersonal skills and the ability to engage and build rapport with diverse populations.

  • Knowledge of prenatal care, maternal health, and cardiovascular health preferred.

  • Experience working with pregnant individuals or in a clinical setting is a plus.

  • Excellent communication skills, both verbal and written.

  • Ability to work independently and as part of a team in a fast-paced environment

  • Proficiency in Microsoft Office Suite and data management systems.

  • Must be able to travel within the state  


Application Process:

Interested candidates should submit a resume, cover letter, and three professional references to

Applications will be reviewed on a rolling basis until the positions are filled.


This job description is intended to provide a comprehensive overview of the responsibilities and qualifications for the Clinical Care Coordinator positions. Specific duties and expectations may vary based on organizational needs and program requirements.

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