Community Resource Specialist, Population Health Management

About Us

As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step.

Our employees use the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide 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 & Collaboration.

General Overview

Across the country, governments, employers, and American families have struggled in the face of rising healthcare costs. Efforts historically have targeted narrow programs and patient populations, and while many have succeeded, healthcare costs continue to rise. It's time to take a radically different approach. A new approach involves putting the patient at the center with the goals of improving value and providing better outcomes at lower cost for patients. The Population Health Management (PHM) department at Mass General Brigham is charged with the challenge to drive better value for patients across Mass General Brigham. To achieve its goals, PHM leverages financial and clinical data to examine opportunities, designs and delivers innovative care models using product development and design thinking disciplines, and leverages problem solving, teamwork, and leadership skills to drive ongoing improvement.

The Behavioral Health (BH) Community Resource Specialist is responsible for managing requests from and finding mental health treatment in the community for adult and pediatric Medicaid patients. The Resource Specialist researches and identifies a customized list of resources to meet the needs of the individual patient, schedules appointments for patients, and communicates the results to both the patient and care team. The position requires a high degree of flexibility, independence, and willingness to participate in multiple activities and provide support to all members of the care team. The position requires strong communication skills and the ability to converse comfortably with patients and their caregivers, practice, and program staff. The BH Community Resource Specialist will play a vital role in assisting the PHM team in achieving its goals and outcomes as well as serving the large Medicaid patient population within Mass General Brigham.

Principal Duties and Responsibilities

Research and document outcomes

* Research resources available for Medicaid adult/pediatric patients with behavioral health treatment needs, including but not limited to: outpatient individual or group therapy, psychiatry, partial hospital programs and inpatient programs
* Uploads referral sources to, and maintains, resource SharePoint database
* Support resource coordination around other patient service needs beyond behavioral health.
* Track and document encounters, resources provided, and case-related communications in the respective electronic health record(s)

Foster relationships with customers and stakeholders

* Work collaboratively with Mass General Brigham primary care, social work and psychiatry providers to support BHI patients. This may include but is not limited to:
* Identify accessible providers for patients, considering insurance coverage, geography, availability to accept new patients, specialty areas, etc.
* Coordination and scheduling of referrals to internal and external resources
* Triage services requests and forward them to other program services as necessary


* Communicate effectively with primary care teams across the Mass General Brigham network, mental health providers in the community, and BHI patients
* Provide timely turnaround of resources to their care teams and promote correct use of resource finding for providers needing support (e.g. who to reach out to centrally)
* Develop strong relationships with community-based mental health providers
* Support resource coordination around other patient service needs beyond behavioral health
* Provide backup coverage for other Resource Specialists as needed

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 & Collaboration

Other duties as assigned

Qualifications

* Bachelor's degree required, preferably in health education, allied health, or related field
* 2 - 3 years of experience interacting with patients and the medical system as related to the duties and responsibilities specified
* Verbal proficiency in 1 or more additional languages (other than English)
* Proficiency in completing program assessments and evaluations within a secure/password protected online database (REDCap) preferred
* Demonstrated technical experience with or willingness to master electronic medical record, web browser, digital platform, and dashboard basics. Experience with REDCap preferred
* Strong listener and team player
* Comfortable with scheduling appointments for a diverse population of patients
* Proficient with MS Office Suite and SharePoint
* Experience conducting chart reviews, managing lists, and documenting notes in EPIC

Preferred:

* Bilingual
* Quality improvement experience is helpful

Skills/Abilities/Competencies

* Must be a team player and a good collaborator
* Ability to multitask and prioritize multiple project requests simultaneously
* An inclusive individual who thrives in a highly matrixed, collaborative, team-oriented environment
* Excellent written and verbal communication skills
* Flexible and adaptable within a complex, multi-site environment with changing requirements
* Flexibility to adapt to program evolution and shifts in prioritization
* Ability to work independently with minimal supervision, as well as part of a cohesive team
* Demonstrated organizational and time management skills
* Ability to learn new technology systems to communicate and document patient cases
* Creativity, flexibility, sound judgment, and ability to take initiative and work well within a team
* Excellent time management and organizational skills
* Demonstrated ability to work both independently and collaboratively


* Excellent interpersonal skills and demonstrated ability to interact professionally with culturally and educationally diverse staff and clients


* Positive attitude, ability to show empathy and compassion


* Compliance with all MGB Human Resources Policies and Procedures related to job title


* Excellent communication skills within an inpatient unit/health care team regarding client concerns

A hybrid work model, with at least one day on-site