Community Health Worker
: Job Details :

General Description: The Community Health Worker (CHW) is responsible for helping patients and their families navigate and access health and community services whiling adopting healthy behaviors. The CHW works as a member of the care team through an integrated approach to care management and community outreach. The CHW works to promote, maintain, and improve the health of patients and their family by providing social support and informal counseling. The CHW partners closely with different providers, patients and outside organizations and is responsible facilitating communication between patient and care teams; and providing culturally-appropriate health education and self-management support. Additionally, the CHW will collaborate within a team-based care delivery model to improve the health and lives of our community members. The CHW will participate in the development and implementation of innovative costs-effective delivery system changes that proactively meet the complex needs of our patients including efforts to manage their behavioral and social needs in addition to their medical care. The CHW will work toward achieving the aims of the overall CHC CHW program as well as any additional grantfunded aims. Reports to: CHW Program Coordinator Salary/Status: Non-Exempt Hours: 40 hours/week NOTE: This position is dependent on Accountable Care Organization/Grant funding. Education and Experience: 1. Minimum of High School GED 2. At least 2-5 years of experience working in community setting preferred License, Certification and Registration Will be required to attend and successfully complete several trainings to meet CHW certification, funding, or regulatory requirements and to meet the needs of the community (may need to supplement any previously completed CHW trainings). Minimum Requirements: 1. Complete fluency in oral and written English and both oral and written fluency in at least one of the most common languages among CHC patients: Spanish, Arabic, Russian, Vietnamese or Nepali) strongly preferred. 2. Ability to use a computer, Microsoft Office, EMR, and proficient in accessing and searching the internet 3. Effective communication skills 4. Strong writing skills 5. Strong organizational and time-management skills, detail-oriented 6. Demonstrated ability to work as an effective team member in a complex and fast-paced environment 7. Excellent interpersonal skills and demonstrated ability to interact professionally with culturally and educationally diverse staff and clients 8. Friendly, reliable, punctual and professional 9. Must possess the ability to work independently, problem solve and make decisions when necessary 10. Must have the ability to work with highly sensitive and confidential information 11. Profecient use of public transportation or MA Drivers license required 12. Willingness to work some weekend/evening hours depending on project and community needs, such as adovacy and community capacity building activites Principle Responsibilities and Duties: 1. Target and outreach, including home visits, to the most vulnerable and at-risk patients and establish positive and supportive relationships 2. Assist with medication adherence, reminding patients about upcoming appointments, arranging transportation assistance and other services patients may need 3. Conduct Care Needs Screenings to the extent of his/her capability 4. Coach patients in effective management of their chronic conditions and self-care 5. Provides basic health education in individual or group sessions and helps patients to develop health management plans that support their achievement of their individualized health and wellness goals 6. Help patients in identifying and utilizing community resources using Health Leads database, in addition to scheduling and accompanying them to appointments, and assisting with completion of application for programs for which they may be eligible 7. Facilitate communication and coordinate services between providers; work collaboratively and effectively within a multidisciplinary team 8. Builds and maintains positive working relationships with the clients, providers, supervisors and all staff 9. Continuously expand knowledge and understanding of community resources and services, public health prevention, and evidence-based intervention programs provided 10. Effectively works with people from diverse backgrounds, including translators, in reducing cultural and socio-economic barriers between clients and institutions 11. Develops and implements culturally and linguistically tailored educational and support activities 12. Collaborates with the care team to track, monitor and report on specified disease-related and patient tracking measures 13. Documents activities, service plans, and results in appropriate data collection tools and/or EMR in a clear and concise manner Working Conditions: 1. This position may require the ability to work long and arduous hours. 2. This position requires the ability to use a computer workstation, viewing a CRT. JOB CODE: 000-0017