Community Health Worker- ACO (Accountable Care Organization)

Baystate Health; Springfield (MA); On-site; USD 27,000 - 47,000; Full time

Job summary

Baystate Health is seeking a Community Health Worker (CHW) to help patients and families navigate health and community services while promoting healthy behaviors. The CHW collaborates with the care team to improve access, education, and self-management support using culturally appropriate approaches.

Key responsibilities include outreach, coordinating with providers, documenting activities in EMR, guiding enrollment in programs, and building strong community relationships to improve health

Qualifications

• GED or HiSET required.
• Reliable transportation and MA Driver's license required.
• Experience working in a community setting preferred.
• Excellent communication and teamwork skills.

Responsibilities

• Develop drive to learn and grow in the CHW role and engage with patients, families, and the medical team.
• Outreach to a specific population, including home or community visits as needed; act as liaison between patients and healthcare providers.
• Work effectively with diverse backgrounds, including translators, to reduce barriers between clients and institutions.
• Assist with medication adherence, remind patients of appointments, and arrange transportation or other services.
• Serve as a key contact at the clinic for enrollment of new members and educate patients on the healthcare system.
• Identify and utilize community resources using an approved database; assist with scheduling and referrals for programs.
• Communicate between providers and the clinical team; collaborate within a multidisciplinary team.
• Build and maintain positive relationships with clients, providers, supervisors, and staff.
• Expand knowledge of community resources, public health, prevention, and evidence-based programs.
• Document all activities in EMR and community service plans clearly; collect data accordingly.
• Complete Care Needs Screenings and other referrals; coach patients on chronic condition management.

Skills

Communication

Cultural competence

EMR documentation

Care coordination

Education

GED or HiSET

High School Diploma or GED

Certified Community Health Worker certification (Massachusetts)

Tools

EMR systems

Community resources database

Job description

At Baystate Health we respect the privacy of our candidates and recruits. Please note that we will not contact candidates directly to ask for personal information over the phone, such as date of birth, social security number, or any other private financial information. Learn More

The Community Health Worker (CHW) is developing skills to help patients and their families navigate and access health and community services while adopting healthy behaviors. The CHW work as a care team member through an integrated approach to care management and community outreach. The CHW is developing skills to effectively promote, maintain, and improve the health of patients and their families by providing social support and informal counseling. The CHW develops strong relationships within the care team and partners with providers, patients, and outside organizations. I am also responsible for facilitating communication between patient and care teams and providing culturally appropriate health education and self-management support. Additionally, CHW will collaborate within a team-based care delivery model to improve the health and lives of our community members.

Job Responsibilities:

1) CHW will develop the drive and determination to learn and grow in the CHW role. I bring positive engagement to daily interactions with patients, families, and the medical team. I am willing to expand my knowledge, abilities, and resilience in the CHW role.

2) Target and outreach to a specific population of patients, including home and/or community visits as needed. Act as key point person between patients and providers of healthcare and social services

3) Effectively works with people from culturally diverse backgrounds, including translators, in reducing cultural and socio-economic barriers between clients and institutions.

4) Assist with medication adherence, reminding patients about upcoming appointments, arranging transportation or other community services patients may need

5) Act as a key contact person within the clinic for enrollment of new members and educate patients on all aspects of the healthcare delivery system

6) Assist in identifying and utilizing community resources using an approved community resource database and demonstrate the use of applicable EMR systems. Assist in scheduling and accompanying patients to appointments as needed and assisting with the completion of applications for programs for which they may be eligible.

7) Communicates between providers and clinical team; work collaboratively and effectively within a multidisciplinary team

8) Build and maintain positive working relationships with the clients, providers, supervisors, and all staff

9) Continuously expand knowledge and understanding of community resources and services, public health prevention, and evidence-based intervention programs provided

10) Effectively utilizes and documents all activities within the EMR and community service plans, resulting in appropriate data collection tools in a clear and concise manner

11) Complete Care Needs Screenings and other applicable screenings to assess the patient's needs and provide appropriate referrals. Coach patients in the effective management of their chronic conditions and self-care

12) Implement culturally and linguistically tailored educational and support activities

13) Collaborates with the care team to track, monitor, and report on specified disease-related and patient tracking measures

Minimally Required Education:

High Schoo/ GED Enrolled or willingness to enroll in CHW certification program

Some exposure to working in a community setting

Required Licensures/Certifications:

Reliable transportation and MA Drivers license are required.

Education:

GED or HiSET (Required)

Certifications:

Certified Community Health Worker – State of MassachusettsState of MassachusettsState of Massachusetts, Driver License – OtherOtherOther

Compensation

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.

Minimum – Midpoint – Maximum

$19.29 – $25.47 – $34.33

Equal Employment Opportunity Employer