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Community Health Worker, Chronic Disease Management

Mass General Brigham
Somerville, United StatesRemotefull_timeVerifiedPosted 13 Apr 2026
💰 $63,420/yr($44,440/yr$63,420/yr)

About the role

Site: Mass General Brigham Incorporated


 

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.


 

Population Health Services Organization is formed by Mass General Brigham to deliver high-quality, low-cost, innovative care. This work stems from Mass General Brigham’s unified system strategy to bring healthcare closer to patients while lowering total healthcare costs.
Our Community Health Workers (CHWs) are integral and trusted members of the community helping our high-risk patients who are getting care at MGB primary care practices receive the services they need to achieve an optimum quality of life. This high-risk patient population presents a unique set of challenges, including higher rates of mental illness and barriers to care, and are often harder to contact and engage, as well as having weaker ties to their primary care practice. The CHW acts as a bridge between our primary care teams and our high-risk patients, improving their access to and utilization of healthcare services.


 

Job Summary

Summary<br>Responsible for providing advanced health education, outreach, and care coordination services to individuals and families in the community. Areas could include exercise, mental health, medication management, nutrition, health care system navigation, substance use and other health behaviors. They work closely with healthcare providers to ensure that patients receive appropriate care and support services to improve health outcomes.<br><br>Does this position require Patient Care?<br>Yes<br><br>Essential Functions<br>-Conduct in-depth assessments of patient needs, goals, and barriers to achieving good health outcomes <br>
-Provide advanced health education and coaching to individuals and families to promote healthy behaviors and self-management of chronic conditions <br>
-Collaborate with healthcare providers to develop and implement care plans for patients with complex health needs <br>
-Assist patients in navigating the healthcare system and accessing appropriate services, including health insurance and social services <br>
-Provide ongoing follow-up and support to patients to ensure continuity of care and successful achievement of health goals <br>
-Develop and implement health promotion programs and activities to address community health needs <br>
-Collect data and maintain accurate records of patient interactions and outcomes <br>
-Attend meetings and trainings related to community health promotion and education <br>


 

Qualifications

Education
Bachelor's Degree Public Health required or Bachelor's Degree Social Work required or Bachelor's Degree Related Field of Study required

Can this role accept experience in lieu of a degree?
Yes

Licenses and Credentials
Community Health Worker [CHW - Massachusetts License] - Massachusetts Board of Allied Health Professionals preferred

Experience
experience in community health outreach, health education, or related field 2-3 years required

Knowledge, Skills and Abilities
- Demonstrated ability to work effectively and provide advocacy for all populations and communities.
- Strong communication and interpersonal skills, with the ability to interact effectively with various populations.
- Ability to work independently and as part of a team.
- Basic computer skills, including Microsoft Office and database management.
- Bilingual skills preferred.


 

Additional Job Details (if applicable)

Physical Requirements

  • Standing Frequently (34-66%)
  • Walking Frequently (34-66%)
  • Sitting Occasionally (3-33%)
  • Lifting Frequently (34-66%) 35lbs+ (w/assisted device)
  • Carrying Frequently (34-66%) 20lbs - 35lbs
  • Pushing Occasionally (3-33%)
  • Pulling Occasionally (3-33%)
  • Climbing Rarely (Less than 2%)
  • Balancing Frequently (34-66%)
  • Stooping Occasionally (3-33%)
  • Kneeling Occasionally (3-33%)
  • Crouching Occasionally (3-33%)
  • Crawling Rarely (Less than 2%)
  • Reaching Frequently (34-66%)
  • Gross Manipulation (Handling) Frequently (34-66%)
  • Fine Manipulation (Fingering) Frequently (34-66%)
  • Feeling Constantly (67-100%)
  • Foot Use Rarely (Less than 2%)
  • Vision - F

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Company

Mass General Brigham

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