Job Description

Circle Health · Lowell General Hospital - Main Campus

The Community Health Worker (CHW) delivers culturally-competent services to help patients of all ages navigate and access community services, other resources and adopt healthy behaviors.  The CHW assists with care coordination tasks such as appointments and/or transportation, patient education and assistance with navigating physical and behavioral health systems, and facilitating communications with providers and other care team members. They will help patients? self-management by evaluating their needs, assisting with plan development, and working towards patient-centered goals.

Duties & Responsibilities

- Meet patients/families in their homes and perform age ?appropriate, structured assessments that include goal setting and motivate patients to meet their health goals.
- Meet patients/families in the emergency department, primary care office, school system (if applicable) or hospital to reinforce and advance patient goals as directed by the Nurse Care Manager. Attend meetings at PCP offices as needed.
- Make weekly follow-up calls and regular home visits to patients and their family units if applicable.
- Arranges and coordinates transportation as needed for patient to attend appointments.
- Provide culturally sensitive services to patients from different cultures.
- Coordinate with the high risk care team to access resources for identified problems including homelessness, substance abuse and food insecurity after assessment by a licensed social worker clinician.
- Assist patients with organizing their records, making follow-up appointments, and filling their prescriptions as well as assisting patients with completing applications for Medical Assistance and SNAP (Supplemental Nutrition Assistance Program).
- Provide advocacy, patient education and support in accessing community-based and hospital-based programs.
- Refer to internal or external care management services when other issues are identified (i.e. food insecurity, domestic violence, etc.). Acts as a patient advocate and liaison between internal and external providers, and community resources to integrate complex services and identify gaps and challenges in care and communication.
- Develop and maintain strong working relationships with the Nurse Care Manager and high risk team, behavioral resource specialist, primary care physician and community partners.
- Document each patient encounter in detail. Prepare reports and documents as needed or requested. Attend a weekly group meeting with - Nurse Care Manager and care team meetings.
- Maintain collaborative, team relationships with peers and colleagues in order to effectively contribute to the working group?s achievement of goals, and tactics to meet the overall organizational goals.
- Other duties as reasonably assigned.

Qualifications:
- 1- 3 years of experience in healthcare related field such as hospital, home health provider, or community-based agency.
- Strong Customer service experience desired
- College Degree preferred
- Detail oriented, with strong organizational skills and multi-tasking abilities
- Knowledge of medical terminology strongly preferred
- Very strong working knowledge and proficiency with technology and business software (Microsoft Office)
Must have reliable transportation for local travel and a valid driver?s license

We are also a proud member of Circle Health and in collaboration with the medical community it is our promise to provide our patients with Complete connected care SM

Circle Health is an Equal Opportunity Employer