Community Health Worker

PRINCIPAL DUTIES AND RESPONSIBILITIES: Indicate key areas of responsibility, major job duties, special projects and key objectives for this position. These items should be evaluated throughout the year and included in the written annual evaluation.

• Conduct initial and interval needs assessments, including assessing social barriers including transportation, housing/rental, food resources, home support, insurance, language, literacy, cultural preferences, and community-based services.
• Help participants set personal health goals and support adherence to those goals through identification of barriers.
• Regularly communicate with participants remotely, or electronically.
• Completes and maintains required study documentation in the appropriate database.
• Completes and documents all participant-related activities in the appropriate database.
• Effectively uses the research team's digital platform(s) when deployed for remote blood pressure monitoring.
• Conducts engagement activities that support participant continuity of care including confirming appointments, ensuring medication access, and establishing care with a primary care physician.
• Support participants in understanding health care plans and tailoring communications to appropriate health literacy levels.
• Regularly communicate with the remote blood pressure monitoring team regarding care for patients.
• Assess participant readiness to make changes by utilizing motivational interviewing skills and promote treatment adherence by providing informal counseling, behavioral change support, and assistance with goal setting and action planning.
• Assist participants with navigating health care and social service systems, including arranging for transportation and scheduling appointments when appropriate.
• Monitor and evaluate participant needs, including those related to prevention, wellness, medical, specialist, and behavioral health treatment, care transitions, and social service needs.
• Identify available community-based resources and actively manage appropriate access, engagement, follow-up, and coordination of services.
• Coordinate participant access to individual and family unmet needs, including resources related to housing, prevention of smoking cessation, chronic disease self-management, self-help/recovery resources, and other services based on individual needs and preferences. Coordinate referrals for the basic determinants of health (e.g., food, clothing, shelter, income, utilities).
• Perform all job functions in compliance with applicable federal, state, local and company policies and procedures. Knowledge or willingness to be trained in HIPAA policies, procedures, and laws.
• Handle and protect confidential and sensitive data with integrity and according to MGH/MGB policy.
• Participate in weekly Pressure Check team meetings

Bachelor's degree in health education, community or public health or allied health or related fields required with fieldwork and patient-facing experience encouraged. Willingness to be trained in protocols associated with IRB, CITI or equivalent certification, and data management. Quality improvement experience is helpful.

Must be able to freely travel to several sites within the greater Boston metropolitan area. Multilingual preferred.

• Creative, flexible, sound judgment, and ability to take initiative and work well within a team.
• Excellent time management, strong attention to detail, and organizational skills.
• Demonstrated ability to work independently and collaboratively.

• Excellent interpersonal skills and demonstrated ability to interact professionally with culturally and educationally diverse staff and clients.
• Positive attitude, ability to show empathy and compassion.
• Proficiency/mastery in written and verbal English language.
• Bilingual/bicultural, especially in Spanish, encouraged to apply.
• Compliance with all MGH/MGB Human Resources Policies and Procedures related to job title.
• Proficiency/mastery of CHW core competencies in providing supportive non-clinical care in patients with co-morbidities including chronic obstructive pulmonary disease, diabetes mellitus, asthma, substance abuse and other chronic disease
• Proficiency/mastery in effectively building health equity through communication, cultural responsiveness, professionalism, patient advocacy, public health application, limit-setting, motivational interviewing, conflict resolution and harm reduction.
• Demonstrated technical experience with or willingness to master electronic medical record, Microsoft Word, Excel, web browser, digital platform and dashboard basics. Experience with REDCap preferred.
• Experience conducting chart reviews, managing lists, and documenting notes

• Completion of a CHW comprehensive outreach education program (e.g., CHEC, BPHC) is strongly preferred.

Hybrid, in-person as needed.

None required.