Complex Patient Populations Community Health Worker
Complex Patient Populations Community Health Worker
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1 Vacancy
Job Description
The community health workerposition requires the ability to be selfdirecting outgoing professionalorganized and to work as a patient advocate with people from many differentcultures and backgrounds.
High school degreerequired. Bachelors degree preferred.
Minimum two years ofworking experience. Previous work incommunity settings preferred.
Demonstratedcommitment to impacting the care of high risk patients.
Experience working asa patient navigator/community health worker preferred.
Ability to work bothindependently and as a team member in multicultural settings.
Fluency in anotherlanguage required.
Detailoriented withthe ability to multitask.
Proficient in allMicrosoft Applications including MS Office and Excel.
Strong time managementorganizational and planning skills.
The goal of the ComplexPatient Team Community Health Worker is to facilitate the most high riskpatients identified by nurses doctors and social workers to adhere to keycomponents of their health care. The community health worker will engagepatients create a trusting relationship navigate patients to importantappointments make follow up home visits and closely communicate with theprovider team based on clear goals set out through the referral process. The community health worker will engagepatients in setting their own short term goals and will track the benchmarksalong the way toward the achievement of these goals. The CPP CHW will aid patients in the coordinationand completion of appointments inside and outside of MGH. In addition thecommunity health worker will work with patients to help decrease barriers totimely followup care. While the community health worker is not a clinicalposition it requires a good knowledge (ability to learn) of basic clinicalconcepts and an understanding of when a referral to a licensed clinician isappropriate.
- Provide communityhealth work services for patients identified as high risk due to medical orpsycho social challenges.
- Completean initial assessment with the patient and provider to identify the specificareas of focus for the CHW role with particular high risk patients.
- Workwith patients and providers to set goals for patients care.
- Motivatepatients for meet their health goals.
- Work with patient to identify and help patient to address barriersto care.
- Provide culturally sensitive services to patients from differentcultures.
- Help thepatient to put systems in place in their own environment to assist with themanagement of their care.
- Help toaddress any logistic barriers scheduling complications child care needsetc. that would prevent a patient from showing up at their appointment.
- Assistpatients in organizing their records making follow up appointments and fillingtheir prescriptions.
- Helppatients to develop their own plans for getting to various appointments for screeningand diagnostic tests and treatment services.
- Accompanypatients to specialty and imaging centers when needed to provide support andadvocacy.
- Make regularhome visits to follow up on key aspects of the patients care and to assess thein home barriers to compliance and engage patients in addressing their barriers.
- Maintainregular communication with the patients providers through clinical messages inLMR emails phone calls and case review meetings.
- Documenteach patient encounter in detail. Trackbenchmarks of progress in care including short term goal completion along theway.
- Workwith primary care providers to reinforce health education messages theimportance of followup care medication adherence routines of self care etc.
- Review andeducate patients on the preparation for colonoscopy pap smear mammogram andother visits to specialty or imaging departments.
- Refer tointernal or external case management services when other issues are identified(i.e. hunger issues domestic violence issues etc.
- Provide advocacy patient education and support in accessingcommunitybased and hospitalbased programs.
- Enternotes of intervention into the appropriate electronic medical record (LMR ETOOnCall)
- Developand maintain a strong working relationship with the schedulers of screeningappointments
- Workwith medical interpreters to reach patients of other languages.
- Producemid year and end of the year reports on program activities compiling data fromdata bases and writing up case examples.
Employment Type
Full-Time
