Site: The General Hospital Corporation
At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission—from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.
At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare — people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds – to apply.
Job Summary
MGH strives to advance health equity, improve health outcomes, and promote well-being of our primary care patients by addressing health-related social needs, system navigation, and care coordination as standard of care.
This position will contribute to these MGH efforts through collaboration with the Department of Equity and Community Health (ECH) and the Department of General Internal Medicine (DGIM) Population Health Management teams.
ECH oversees a team of Community Health Workers. CHWs are trusted members of the community with the skills and experience to understand their patients’ circumstances. By building trusting relationships and walking alongside their patients, CHWs help address medical and psychosocial needs in order to promote self-efficacy, help patients meet their goals, and improve health outcomes.
The DGIM Population Health Management team develops and implements population-based efforts to monitor and improve clinical effectiveness through systems-based strategies and interventions. Its goal is to improve the quality and cost effectiveness of health care by informing clinical decision-making processes, changing patient and clinician behaviors, enhancing the care choices of physicians, other providers and patients, and optimizing care tools and systems.
The Community Health Worker (CHW) will be part of the pediatric CHAMPION Program’s multi-disciplinary care team which includes a physician and dietitian. The evidence-based CHAMPION program and research study seeks to evaluate whether telehealth vs. in-person delivery of CHAMPION is equally effective at reducing child BMI and asthma control in diverse lower income families. The CHAMPION program consists of individual and group visits guided by a set curriculum with a multi-disciplinary team (medical provider, dietitian, and community health worker), and other tools to support behavioral change and reduce body mass index (BMI) and asthma, such as follow-up phone calls, educational materials, social determinants of health screening and referral and text messaging. The CHW will provide case management for children and adolescents with overweight/obesity and asthma, through group and individual visits, both in-person and virtually. The CHW will support patient follow-up, goal completion, motivation, and connection to community-based organizations to support lifestyle change. The CHW will also participate in the Virtual Learning Community and Quality Improvement calls and activities, and will be responsible for clinical scheduling, reminder calls, telehealth technical assistance, and other visit management tasks.
Under the management of ECH and DGIM, the asthma-lifestyle CHW will participate in patient-centered, team-based care. S/he/they will support primary care physicians (PCPs) and practices in managing their panel of patients with asthma and/or obesity. S/he/they will incorporate the PCP’s clinical goals and family goals to identify plans of action. By gathering and organizing patient data from clinical registries and medical records, the asthma-lifestyle CHW works to identify patients’ unmet needs, engage patients in self-management, gather summary information for treatment interventions, and provide wrap-around support that traditionally falls outside of clinical care.
The CHW will engage patients and their families, develop a trusting relationship, help families to navigate the health system, make home visits to identify environmental influences and closely communicate with the clinical team based on clear clinical goals set out during the referral process. In addition, the CHW will engage patients and their families in setting their own short-term goals and will track the benchmarks along the way toward the achievement of these goals. In addition, the asthma-lifestyle CHW will work with patients to help decrease barriers to timely follow-up care and provide coaching to engage patients and families in identification and achievement of care goals.
This is not a clinical position but requires a good knowledge of (and willingness to learn) basic clinical concepts and an understanding of when a referral to a licensed clinician is appropriate.
Qualifications
Key Areas of Responsibility:
Principle Duties and Responsibilities:
Patient Engagement and Health Coaching
Systems Navigation and Care Coordination
Collaboration and Documentation
Additional Ad-hoc Responsibilities (generally on an as-needed basis):
Additional Job Details (if applicable)
. High school diploma or GED required.
. Relevant experience in the community or bachelor’s degree preferred; preference for Psychology/Social Work/Public Health or related field.
. Three years of experience in the field, pediatric healthy weight management training or experience and motivational interviewing training is desired.
. Position is grant funded.
. English language proficiency is required.
Skills/Abilities/Competencies Required:
. Ability to work both independently and as a team member in multicultural settings.
. Proficient in Microsoft Applications, including MS Word and Excel.
Remote Type
Hybrid
Work Location
151 Everett Avenue
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
EEO Statement:
The General Hospital Corporation is an Affirmative Action 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.
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
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