Chronic Care Assistant, Population Health Management
Mass General Brigham
- Somerville, MA
- Permanent
- Full-time
The Assistant will use Mass General Brigham healthcare values to govern decisions, actions, and behaviors. These values govern how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & CollaborationPrincipal Duties and Responsibilities
- Conducts initial intake and assessment for patients identified or referred by a primary care clinician
- Delivers patient and caregiver conditions specific care protocols as appropriate.
- Provides education to patient/care giver on disease specific information
- Manages data entry into Mass General Brigham EPIC system (electronic patient medical record) or other patient database.
- Schedules initial patient virtual visit
- Evaluates and tracks patient enrollment status in the program
- Establishes and schedules standard cadence for follow up with patient. Connects patient to appropriate resources
- Manages care coordination needs for patient they are following including social related health needs
- Works closely with programs’ interdisciplinary teams in providing patient care
- Supports administrative needs of central team as needed
- Other duties as assigned
- Bachelor’s degree preferred with 1-2 years of health care experience (internships and fellowships are considered as experience)
- Bilingual - Spanish/English fluency preferred (speaking, reading, writing), but not required
- A combination of education and experience in a healthcare or related setting may be substituted for requirements
- Willingness to work with patients and caregivers in both clinic and home settings
- Familiar with local resources and services
- Friendly, outgoing personality
- Solid team player but also an independent thinker
- Strong interpersonal and team building skills. Ability to get work done through others.
- Respect the talent and unique contribution of every individual, culture and ethnic group and treat all people in a fair and equitable manner
- Teaching/coaching skills
- Strong communication and collaboration skills
- Problem solving skills
- Basic computer skills which include a familiarity with Microsoft Office 365
- The Assistant will demonstrate ability to:
o communicate clearly and concisely, both verbally and in writing
o remain calm and work well under pressure
o establish and maintain effective working relationships with superiors, coworkers, patients and families.
o work independently
o prioritize and multi-task in a fast-paced environment
o interact with patients from all economic, educational, and social backgrounds
o treat all patients with dignity and respectA hybrid work model – primarily working at the MGB office in Assembly Row with an ability to flex to remote work or travel to the MGB primary care practice locations, and community settings including patient’s home as appropriate based on the needs of the patient and the clinical intervention.