Lead Community Health Worker

Job Description

Job Description

Description:

The Lead Community Health Worker (CHW) advances health equity by addressing Social Determinants of Health (SDoH) and supporting improved outcomes for Fenway Health’s diverse patient population. Working in close partnership with medical providers, care teams, and community organizations, this role helps drive whole-person, integrated care.

Under the direction of the Manager of Behavioral Health Integrated Services, the Lead CHW delivers direct patient support while also strengthening the CHW program. This includes mentoring and training team members, supporting program coverage, and supervising interns and students. As a leader on the team, the Lead CHW fosters engagement, builds capacity, and ensures high-quality, patient-centered support across all Fenway Health clinical locations.

Representative Duties:

Care Coordination

• Support the Nurse Care Coordinators with care coordination requests.
• Provides coverage of care coordination duties as needed.
• Assists patients with completion of paperwork.
• Provide patients with updated and accurate information regarding care coordination services.
• Actively build good working relationships with clients and colleagues
• Assists patients with applications for enrollment in programs as needed.
• Document in EHR for each patient interaction
• Assists department with care coordination administrative tasks such as completing and faxing client paperwork.
• Assist with outgoing phone calls to community resources as needed.
• Assists with distributing program materials to clients via mail as needed.
• Convey the purposes and services of a program to the patient population and the impact that program or service would have.
• Help patients develop health management plans and goals.
• Follow-up with health management/care plans with both patients and providers
• Coach patients in effective management of their chronic health conditions and self-care
• Assist patient in understanding care plans and instructions.
• Document activities, service plans, and results in an effective manner while strictly adhering to the policies and procedures in place.
• Establish positive, supportive relationships with participants and provide feedback.
• Assist patients in accessing health related services, including but not limited to: obtaining a medical home, providing instruction on appropriate use of the medical home, overcoming barriers to obtaining needed medical care and social services
• Facilitate communication and coordinate services between providers.
• Motivate patients to be active, engaged participants in their health.
• Build and maintain positive working relationships with the clients, providers, nurse case managers, agency representatives, supervisors and office staff.
• Continuously expand knowledge and understanding of community resources, services and programs provided; human relations and the procedures used in dealing with the public as part of a service or program; volunteer resources and the practices associated with using volunteers, operations, functions, policies and procedures associated with the department or program area, procedures and resources available to handle new, unusual or different situations.

Collaborates with other agencies:

• Develops maintains resource listings appropriate for Fenway Health patients
• Participates in community councils, boards and groups as appropriate to further departmental objectives
• Works with Medicaid, Medicare, Welfare, Social Security, housing, educational, day care and other institutions to assist clients
• Consults with a variety of health center and community staff (Nutritionists, Home Health Aides, Nurses, Behavioral Health staff and Medical staff) about specific clients and general approaches to patient treatment

Performs and completes administrative tasks in a timely and efficient manner:

• Writes case notes for each client interaction within 48 hours of interaction
• Assists clients with applications for enrollment in entitlement programs
• Assists medical teams with community resource administrative tasks
• Participates in staff and team meetings and conferences
• Participates in professional activities to maintain professional standing
• Participates in program reporting and accountability as required by funding agencies

Provides training, supervision and support to assigned students/interns following Fenway policies and procedures:

• Supervises interns/students on the CHW team as needed.
• Provides ongoing guidance and supervision to CHW interns/students as needed.
• Provides written evaluations of CHW interns/students as needed, following program and agency evaluation guidelines.

Provides training and support to CHW staff members following Fenway policies and procedures:

• Collaborates with supervisor to develop/maintain a comprehensive program orientation for CHW team members.
• Provides training for CHW team members during orientation and as needed regarding the full range of their responsibilities.
• Provides resource information and consultation on an as needed basis to other CHWs.
• Assist the Supervisor with program innovation and initiatives.

Meets agency participatory expectations:

• Suggests and participates in continuing quality improvement efforts
• Adheres to all agency and departmental policies and procedures
• Participates in quality assessment and improvement activities as requested
• Adheres to the highest principles of patient and client confidentiality
• Adheres to established safety policies, procedures and precautions; identifies potential or actual unsafe situations in the environment and takes measures to rectify the situation
• Attends all required meetings, in-services and professional trainings
• Attends all regularly scheduled research meetings, trainings, forums and pertinent FCH staff meetings
• Maintains professional competence necessary to perform job responsibilities; maintains and provides agency with records of continuing education activities
• Serves on agency committees and in professional organizations when requested

Performs related duties as required

• Requires a Bachelor’s Degree
• A minimum of 2 years of experience as a Community Health Worker
• Demonstrated ability to work respectfully and effectively with individuals from a wide range of backgrounds, perspectives, and life experiences. This includes engaging constructively with colleagues, patients, clients, and vendors in a manner that reflects professionalism, empathy, and cultural awareness, without regard to race, color, national origin, sex, gender identity, sexual orientation, religion, age, disability, or other protected characteristics as defined by applicable law.

Preferred Qualifications:

• Experience working with an ethnically, culturally and racially diverse work staff
• Experience with LGBTQIA+ populations
• Prior case management experience in a medical setting and experience working with people who are living with HIV
• Bilingual in Spanish 

Physical Requirements:

Ability to meet the following physical requirements with or without reasonable accommodations:

• Sit at a computer station for extended periods of time
• Ability to keyboard for extended periods of time