What are the responsibilities and job description for the Community Health Worker, Care Management - Florence position at Cooley Dickinson Medical Group?

We are seeking a full-time, 40-hour Community Health Worker (CHW) to join our team supporting the Integrated Care Management Program (iCMP)! This is a hybrid opportunity, with a schedule of Monday-Friday 8 : 30am-5 : 00pm. On Tuesdays, the CHW will typically be in office at 10 Main Street in Florence, MA, and the other 4 days of the week would be remote work and travel as needed to meet with our patients out in the community areas of Amherst, MA and Greenfield, MA. The CHW will need reliable transportation to meet these travel needs. The schedule can be flexible depending on the department's and patient's needs.

Responsibilities include :

Build individual and team capacity
Involve participants in self and community advocacy
Map communities to help locate support services (i.e. housing, food, shelter, community services, etc.), working closely with the iCMP Community Resource Specialist to achieve this and educate other team members on resources found
Connect families with needed resources, including tracking referrals when appropriate
Assist patients and families in applying for State resources and services (i.e. Mass Health, DTA, DDS, and DMH). This may include helping them gather necessary documentation, filling out forms, and helping them anticipate and prepare for re-applications when needed
Follow up with families on status of applications
Locate and coordinate services for children with Autism (i.e. ABA therapy, social skills groups, camps, in-home supports)
Locate mental health providers within a patient's insurance network and collaborate with PCP and iCMP Team on ensuring referrals to appropriate providers
Attend meetings regarding educational and mental health services for patient
Support families in advocating for services. Attend 504 / IEP meetings with families. Coordinate with iCMP Care Team and PCP meeting details and next steps
Attend meetings with patient / family in the community. Provide updates to iCMP SW / CM and PCP
Provide peer support to families struggling with behavioral health issues
Assist with cultural mediation between communities and health and human services systems
Provide culturally appropriate health education
Make follow up calls and home visits when needed to patients and families.
Assist patients with organizing their records and making follow up appointments
Document patient encounters in electronic medical record
Attend weekly supervision and team meetings
Develop and maintain strong working relationships with iCMP Social Workers, iCMP Nurse Care Managers, primary care providers, etc.
Perform other functions / duties as requested

Required

Strong understanding of psychiatric and family system and ability to use this understanding to formulate succinct case summaries required

Good organizational and time management skills and the ability to set up systems to help others with these skills required

Strong interpersonal skills enabling effective team collaboration required

Demonstrated ability to be flexible and adapt to a complex, fast-paced medical environment required

1-2 years of prior experience working with patients and families dealing with complex medical and psychiatric / behavioral problems; the ability to help patients and families / caregivers understand and access the resources required to support care, ideally with experience in private / public educational systems, community mental and behavioral health centering on holistic patient and family care required

High school diploma or equivalent preferred; relevant experience in the community or Associates Degree required; Bachelor's Degree preferred

Bilingual preferred

Experience as a community health worker, peer specialist, peer advocate, or a similar role preferred; firsthand or secondhand experience dealing with behavioral health issues, navigating the behavioral health care system, and / or navigating the special education system in Massachusetts preferred

Strong computer skills and use of Microsoft Word / Excel / Outlook required; experience with electronic medical records preferred

Mass General Brigham Medical Group Western Massachusetts, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and / or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

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