Community Health Worker

Community Health Worker (CHW) will with specific target populations on identifying and address Social Determinants of Health (SDoH). CHWs will work closely with medical providers primary care teams and other agencies to improve patient care and outcomes.

Under the direction of the Nursing Leadership Care Coordination Nurse Manger and the Nurse Care Coordinators the CHW will provide patient support and provide specialized and focused assistance and other duties as assigned at all Fenway Health clinical locations.

Principal Duties and Responsibilities:

Care Coordination

• Support the Nurse Care Coordinators with care coordination requests
• Provides coverage of care coordination duties as needed
• Assists patients with completion of paperwork
• Provide patients with updated and accurate information regarding care coordination services
• Actively build good working relationships with clients and colleagues
• Assists patients with applications for enrollment in programs as needed
• Document in EHR for each patient interaction
• Assists department with care coordination administrative tasks such as completing and faxing client paperwork
• Assist with outgoing phone calls to community resources as needed
• Assists with distributing program materials to clients via mail as needed
• Convey the purposes and services of a program to the patient population and the impact that program or service would have
• Help patients develop health management plans and goals
• Followup with health management/care plans with both patients and providers
• Coach patients in effective management of their chronic health conditions and selfcare
• Assist patient in understanding care plans and instructions
• Document activities service plans and results in an effective manner while strictly adhering to the policies and procedures in place
• Establish positive supportive relationships with participants and provide feedback
• Assist patients in accessing health related services including but not limited to: obtaining a medical home providing instruction on appropriate use of the medical home overcoming barriers to obtaining needed medical care and social services
• Facilitate communication and coordinate services between providers
• Motivate patients to be active engaged participants in their health
• Build and maintain positive working relationships with the clients providers nurse case managers agency representatives supervisors and office staff
• Continuously expand knowledge and understanding of community resources services and programs provided; human relations and the procedures used in dealing with the public as part of a service or program; volunteer resources and the practices associated with using volunteers operations functions policies and procedures associated with the department or program area procedures and resources available to handle new unusual or different situations

Attends to healthcare issues of specific populations

• Provides agespecific culturally responsive care per Fenway Community Health policy
• Works with the care team to complete processes so that patients may receive benefits such as durable medical equipment and medical leave approvals
• Conducts outreach and coordinates with medical case managers to mitigate barriers to engagement in care
• Provide high degree of customer service
• Outreach to patient to obtain necessary information related to case management needs
• Be sensitive to handling sensitive medical and behavioral health information

Provides health education

• Provides community health education
• Provides patient education related to their medical and psychosocial needs
• Maintains comprehensive knowledge of vaccines medications and other therapeutic interventions as appropriate to our outpatient clinic
• Accesses Nursing Department resources to ensure patients are provided most up to date and evidencebased information
• Maintains comprehensive knowledge of Fenway Health policies procedures and services including those of TFI
• Maintains knowledge of community resources
• Assists in training other employees in the medical department including orientation of new staff volunteers and students

Effectively communicates with patients coworkers on medical team in medical department and across departments

• Effectively work with people (staff clients doctors agencies etc) from diverse backgrounds in reducing cultural and socioeconomic barriers between clients and institutions
• Demonstrates competency in EMR Microsoft Outlook etc
• Attends and participates in regularly scheduled general staff meetings as well as Nursing meetings (e.g. MDSM)
• Is available to meet with team members during assigned work hours
• Understands and abides by HIPAA regulations
• Demonstrates a commitment to strong customer service
• Ability to work as a team member

Meets Agency Participatory Expectations

• Suggests and participates in continuing quality improvement efforts
• Adheres to all agency and departmental policies and procedures
• Participates in quality assessment and improvement activities as requested
• Adheres to the highest principles of patient and client confidentiality
• Adheres to established safety policies procedures and precautions; identifies potential or actual unsafe situations in the environment and takes measures to rectify the situation
• Attends all required meetings inservices and professional trainings
• Attends all regularly scheduled research meetings trainings forums and pertinent FCH staff meetings
• Maintains professional competence necessary to perform job responsibilities; maintains and provides agency with records of continuing education activities
• Serves on agency committees and in professional organizations when requested

Performs other related duties as required

• High School Diploma
• Knowledge of MS Office suite particularly Excel and Outlook
• Strong organizational and attention to detail skills
• Ability to handle multiple tasks and prioritize assigned duties
• Ability to work harmoniously with diverse groups of individuals required
• Ability to work harmoniously and effectively with colleagues patients clients and vendors across the spectrum of diversity including but not limited to race ethnicity color gender identity sexual orientation age socioeconomic status national origin and immigrant status religious or spiritual identity disability (physical mental emotional and developmental) veteran status and/or limited English proficiency.
• Willingness to contribute towards Fenways efforts in becoming an antiracist organization and promoting a culture dedicated to ongoing development in service of humility equity diversity inclusion and belonging where differences are acknowledged and valued.

Preferred Qualifications:

• AS or BS in psych/public health or related field
• Office management experience
• Experience with LPBTQ patient populations
• Work with addressing SDoH
• Relevant administrative experience in a Behavioral Health/Public Health and/or a medical setting
• Experience working with an ethnically culturally and racially diverse staff