Spanish Community Health Worker Pediatric
Spanish Community Health Worker Pediatric
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Job Description
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
SummaryResponsible for providing advanced health education outreach and care coordination services to individuals and families in the community. Areas could include exercise mental health medication management nutrition health care system navigation substance use and other health behaviors. They work closely with healthcare providers to ensure that patients receive appropriate care and support services to improve health outcomes.
Does this position require Patient Care Yes
Essential Functions
-Conduct in-depth assessments of patient needs goals and barriers to achieving good health outcomes
-Provide advanced health education and coaching to individuals and families to promote healthy behaviors and self-management of chronic conditions
-Collaborate with healthcare providers to develop and implement care plans for patients with complex health needs
-Assist patients in navigating the healthcare system and accessing appropriate services including health insurance and social services
-Provide ongoing follow-up and support to patients to ensure continuity of care and successful achievement of health goals
-Develop and implement health promotion programs and activities to address community health needs
-Collect data and maintain accurate records of patient interactions and outcomes
-Attend meetings and trainings related to community health promotion and education
Qualifications
Research indicates housing food financial and other forms of socioeconomic insecurity impact health outcomes. To improve our patients health and wellbeing MGH primary care patients are asked to complete a social determinants of health (SDH) survey annually. The goal is to identify and address SDH early by assessing and referring patients to internal and external resources. This role will work with families of pediatric patients who have screened positive for SDH needs. This role will work closely with the Medicaid ACO Community Resource Navigator (CRN) role group with the Integrated Care Management (iCMP) Community Resource Specialist (CRS) group and the Pediatric Department
The Medicaid ACO and iCMP resource navigation teams have recently merged to build on best practices to advance health equity improve health outcomes and promote well-being of our MGH Primary care patients by addressing health-related social needs system navigation and care coordination as standard of care. The role collaborates to enhance the delivery of patient care services along the continuum of care bridging communication about patient social needs and resources available to them back to the clinical team. This position involves problem solving to ensure each unique patient is evaluated for their unique abilities and capacity in addition to their identified SDH needs.
Principal Duties and Responsibilities:
Assess patients/families who have screened positive on one or more of the SDH questions
- Determine the scope of the patient/familys need and familys ability to follow through and take action on appropriate
resources
- Identify previous or current efforts to address the need
- Identify previous or current engagement with internal and/or external resources
Provide patient education and referral to resources
- Identify and provide information on the network of services and eligibility including service provider addresses
telephone number and as available contact person; may involve investigation and outreach to internal
and community providers
- Follow up with patients to confirm engagement and respond to outstanding questions or re-refer as appropriate.
Assess if there are other care coordination needs within the medical behavioral health or social systems.
- Connect to primary care formal case management social work or other appropriate Population Health programs.
Documentation
- Systematic and uniform documentation to record engagement with patient including education and referral to resources.
- Systematically communicate with the patients care team about engagement with the patient referrals and other appropriate patient information.
- Identify and document gaps in internal and external services and improve workflows and resource tools when needed.
Additional Job Details (if applicable)
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$20.43 - $29.21/HourlyGrade
4EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Employment Type
Part-Time
