ACO Community Health Worker

MountainOne; Pittsfield, Northern (MA, KY); Hybrid; USD 42,000 - 60,000; Full time

Job summary

MountainOne is seeking a Community Health Worker to support patients with complex health and social needs. The CHW engages high-risk and rising-risk patients, helps overcome barriers related to social determinants of health, and improves connection to primary care and community resources.

The CHW works closely with an interdisciplinary care team to help patients navigate the healthcare system, build self-management skills, and reduce avoidable ER visits and hospitalizations.

Job description

The Community Health Worker (CHW) plays a critical, front-line role in supporting patients with complex health and social needs. This role focuses on engaging high-risk and rising-risk patients, addressing barriers related to social determinants of health, and improving connection to primary care and community resources.

CHWs work closely with an interdisciplinary care team to support patients in navigating the healthcare system, building self-management skills, and reducing avoidable emergency department visits and hospitalizations.

This is a relationship-driven, community-rooted, and fast-paced role that requires strong communication skills, resourcefulness, and the ability to build trust quickly.