Community Health Worker II / 40 Hours / MGH-All Locations including Health Centers
Company: Massachusetts General Hospital
Posted on: June 8, 2021
MGH strives to advance health equity, improve health outcomes,
and promote well-being of our primary care patients by addressing
health-related social needs, system navigation, and care
coordination as standard of care. Community Health Workers (CHWs)
are an integral part of achieving these goals.
CHWs build trust with their patients and help them to improve
access and coordinate their health care. CHWs have the skills and
experience to understand their patients' circumstances. By walking
alongside their patients, CHWs help to address medical and
psychosocial needs in order to promote self-efficacy, help patients
meet their goals, and improve health outcomes.
CHWs use their unique skills (motivational interviewing, trauma
sensitive care, coaching, etc.) to help patients manage their
chronic diseases, adhere to medications, connect to community
resources and gain strength and confidence in managing their own
health. In addition, the community health worker will work with
patients to help decrease barriers to timely follow-up care in the
midst of challenging social, environmental and economic situations.
The CHW will aid patients in the coordination and completion of
appointments inside and outside of MGH. CHWs will work with
patients to alleviate social determinants of health as well as
improving their overall health and well-being. While the community
health worker is not a clinical position, it requires a good
knowledge (ability to learn) of basic clinical concepts and an
understanding of when a referral to a licensed clinician is
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Patient Engagement and Assessment
- Provide community health work services for patients identified
as at-risk due to medical or psychosocial challenges.
- Complete an assessment with the patient and provider to
identify the specific areas of focus for the CHW work with
particular at-risk patients.
- Engage with patient, build trust and identify patient's
barriers. Work with patients and providers to set goals for
- Educate, motivate and guide patients to meet their health
- Provide culturally sensitive services to patients from
- Help the patient to put systems in place in their own
environment to assist with the management of their care.
System Navigation, Health Coaching and Care Coordination
- Help to address any logistic barriers, scheduling
complications, childcare needs, etc., that would prevent a patient
from showing up at their appointment.
- Assist patients in organizing their records, making follow up
appointments and filling their prescriptions.
- Help patients to develop their own plans for getting to various
appointments for screening and diagnostic tests, and treatment
- Accompany patients to specialty and imaging centers when needed
to provide support and advocacy.
- Meet patients in the community or in a safe outdoor space to
conduct visits when and where appropriate to follow up on key
aspects of the patient's care and to assess the in-home barriers to
- Work with primary care providers to reinforce health education
messages - the importance of follow-up care, medication adherence,
routines of self-care, etc.
- Review and educate patients on the preparation for colonoscopy,
pap smear, mammogram, and other visits to specialty or imaging
- Refer to internal or external case management services when
other issues are identified (i.e. hunger issues, domestic violence
- Provide advocacy, patient education and support in accessing
community-based and hospital-based programs.
- Develop and maintain a strong working relationship with the
schedulers of screening appointments
- Work with medical interpreters to reach patients of other
Collaboration and Documentation
- Maintain regular communication with the patient's providers
through clinical messages in the electronic health record, emails,
phone calls and case review meetings.
- Document each patient encounter in detail. Track benchmarks of
progress in care - including short term goal completion along the
- Enter notes of intervention into the appropriate electronic
- Produce mid-year and end of the year reports on program
activities compiling data from data bases and writing up case
The community health worker position requires the ability to be
self-directing, outgoing, professional, organized and to work as a
patient advocate with people from many different cultures and
SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:
- BS in Psychology/Social Work/Education/Public Health or related
field preferred. High school degree required.
- Minimum two years of working experience. Previous work in
community settings and/or medical settings preferred.
- Demonstrated ability to work effectively and provide advocacy
for racial and ethnically diverse populations and communities.
- Strong commitment to social justice and health equity.
- Demonstrated commitment to impacting the care of at-risk
- Experience working as a patient navigator/community health
- Ability to work both independently and as a team member in
- Detail-oriented with the ability to multi-task.
- Strong oral and written communication skills.
- Proficient in all Microsoft Applications, including MS Office
- Strong time management, organizational and planning
Need to be able to work from home, in the community and in the
Keywords: Massachusetts General Hospital, Chelsea , Community Health Worker II / 40 Hours / MGH-All Locations including Health Centers, Other , Chelsea, Massachusetts
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