At Mass General Brigham we believe in equal access to quality care, employment and advancement opportunities encompassing the full spectrum of human diversity: race, gender identity, sexual orientation, ability, religion, ethnicity, national origin and all the other forms of human presence and expression that make us better able to provide innovative and cutting-edge healthcare and research.

A Community Health Worker (CHW) is a vital role within Brigham and Women's Primary Care Social Care Team. A CHW is a trusted member of the community who supports patients to better access and coordinate their health care. In partnership with patients, CHWs have the skills and experience to navigate resources and support patients to get through difficult experiences [overcome obstacles to living their healthiest lives]. CHWs come from the communities they serve and act as an extension of caring neighbors to support patients meet their social and medical needs that can lead to better health outcomes. The CHW dedicates their time and establishes a trusting relationship with patients to address social determinant of health (SDOH) needs such as food, housing, transportation, and connecting them to resources. In addition, the CHW will work with patients to help decrease barriers to full and effective engagement with primary care, including preventive care and chronic disease management - for example, timely follow-up care. While the Community Health Worker is not a clinical position, it requires knowledge of (ability to learn) basic clinical concepts and an understanding of how primary and social care teams work together to achieve best possible health outcomes.

• Provide community health work services for patients due to medical or social care needs identified, including short term intensive case management and in person support as needed to advocate for appropriate services, benefits, and programs.
• Support community resource finding related to Social Determinants of Health (SDOH) needs, including housing, food, transportation, utilities, medication costs, elder care, childcare, job search, and education needs.
• Work in partnership with the patient to identify and address barriers to care.
• Collaborate with patients and providers to set goals for patient's care and motivate patients to meet their health goals. Document and track progress accordingly.
• Provide culturally sensitive and responsive services to patients from diverse cultures and communities.
• Support the patient to further develop systems within their environment to assist with the overall management of their care.
• Co-develop strategies to reduce logistic barriers to care, such as, scheduling conflicts, childcare needs, and transportation that would prevent a patient from attending appointments, tests, treatment, etc.
• Assist patients in organizing their records, making follow up appointments and filling their prescriptions as needed.
• Accompany patients to appointments when needed to provide support and advocacy.
• Identify patient strengths to manage their own care and/or engage household members as advocates.
• Meet patients in the community or conduct "porch" visits when and where appropriate to follow up on key aspects of the patient's care, assess barriers within the home and identify potential solutions.
• Maintain regular communication with the patient's provider and provider's care teams through health record database, emails, phone calls and case review meetings.
• Follow documentation guidelines and protocol within health record database and other areas as assigned and determined by primary and social care team.
• Work with primary care providers to reinforce health education messages - the importance of follow-up care, medication adherence, routines of self care, etc.
• Refer to internal or external care management services when additional capacity is required to meet other social care needs (i.e., food insecurity, domestic violence, etc.)
• Assist patients fill out applications for public and community services such as, Medical Assistance, Housing, and SNAP (Supplemental Nutrition Assistance Program).
• Provide advocacy, patient education, and support - including accompaniment - in accessing community-based and hospital-based programs.
• Work in partnership with clinic-based care team, including schedulers, practice assistants, nurses, medical interpreters, and others.
• Contribute to mid-year and end of the year reports describing program and case examples.
• Attend initial and continuing education training programs including self-directed reading and in-person and online learning.
• Other duties as assigned.

The community health worker position requires the ability to be self-directing, motivated, outgoing, professional, goal-oriented, organized and to work as a patient advocate with people from diverse cultures and backgrounds.

• Minimum two years of relevant work experience in the community or Associates Degree
• High school degree required.

• Knowledge of community-based program services, public benefits, and other resources.
• Excellent communication skills.
• Strength in authentically connecting with people from all walks of life with empathy and humility.
• Ability to listen and connect with people from all walks of life.
• Strong attention to detail and prioritization.
• Familiarity and willingness to learn service approach models (e.g., trauma informed, cultural humility, strength-based, and others).
• Strong time management and planning skills.
• Ability to make connections across internal and external teams of care.
• Excellent organizational skills given coordination of multidisciplinary team, various logistical components, data acquisition.
• Ability to work well within a team and independently.
• Computer skills: working knowledge, familiarity with computer, software including use of email, excel.
• Willingness to learn and further develop skills reflective of best practices and trends in the field.
• Fluency in Spanish, Haitian Creole, Cape Verdean Portuguese preferred.

Need to be able to work from home, office, or community, and travel to and from visits and meetings.

Brigham and Women's Hospital is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, national origin, sexual orientation, protected veteran status, or on the basis of disability.