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  3. Community Health Worker, Behavioral Health Transition of Care
CC

Community Health Worker, Behavioral Health Transition of Care

Community Care Cooperative·Boston, Massachusetts

$27 - $32/hr·Full Time·Hybrid·2-5 yrs
·Posted 1 day ago
Practice for this role

About the role

The Community Health Worker will support patients with complex mental health and substance use needs by conducting outreach, coordinating care, and assisting with social service applications. They will work as part of an integrated care team to facilitate transitions of care and ensure patients meet their clinical and psychiatric goals.

Location: North east massachusetts (Hybrid)

Organization summary

Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices across Massachusetts. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.

Job summary

The Community Health Worker (Transitions of Care Program) will be a member of a team of social workers, physicians, pharmacists, community health workers, and program coordinators, you will have the opportunity to make a profound impact on the lives of people living with complex and/ or chronic mental health conditions, many of whom also face multiple barriers to accessing care and adhering to a provider’s treatment plan. The CHW works as an extension of the clinical care team. You will connect with your patients in person, on the phone, in the hospital, and in the provider’s office. You must be prepared to work from home office, hospital, Health Center, provider’s office setting, within patient’s homes, or in the community.

Responsibilities

  • Works under the guidance of the Behavioral Health TOC Social Work Care Manager
  • Conducts initial outreach calls to encourage patients and caregivers to participate in care management programs
  • Meet with members in person in the community and/or at the health centers
  • Engages with patients who need assistance with psychiatric and/or substance use recovery care needs
  • Addresses language and cultural barriers to care
  • Coaches and guides the patient to meet psychiatric and other clinical goals
  • Helps teach the patient and/or care giver about psychiatric and/or substance misuse symptoms response plans
  • Assists in scheduling appointments on behalf of patients and reminds patients of their upcoming visits
  • Accompanies patients to their visits as needed
  • Completes Social Determinants of Health Assessments
  • Helps patients access community and government-based service agencies including filling out paperwork for the patient
  • Arranges transportation as needed (PT1)
  • Establishes relationships with community agencies, resources, and supports that are relevant to the Medicaid population
  • Assists with Medicaid applications, food and nutrition benefits, housing applications, coordinating transportation, etc.
  • Travels to engage members at their homes or in the community
  • Participates in the integrated care team meetings and rounds as required
  • Maintains accurate, timely documentation in electronic systems
  • Provides team support as needed

Required Skills

  • Demonstrated success in working as part of a multi-disciplinary team including communicating and working with providers, nurses, and social workers
  • Experience working with patients with chronic and mental health and/or substance misuse needs
  • Must be flexible and adaptable to change
  • Ability to work independently
  • Excellent interpersonal communication skills
  • Additional qualities that would be a good fit for our team include enthusiasm and passion for helping patients, genuine spirit, kind and empathetic nature
  • Experience working with Electronic Medical Records and healthcare systems
  • Experience and proficiency with Microsoft Office and online record keeping

Desired Other Skills

  • Familiarity with the MassHealth ACO program
  • Familiarity with Federally Qualified Health Centers
  • Experience with anti-racism activities, and/or lived experience with racism is highly preferred
  • Bi-lingual (preferred)

Qualifications

  • Experience working with Medicare, Medicaid and/or Special Needs populations
  • A valid driver's license and provision of a working vehicle
  • *
  • In compliance with Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **

Requirements

Candidates should have experience working with Medicare, Medicaid, or special needs populations and possess strong interpersonal and communication skills. A valid driver's license and a working vehicle are required to facilitate travel to patient homes and community settings.

  • Case Management
  • Documentation
  • Interpersonal Communication
  • Crisis Intervention
  • Microsoft Office
  • Care Coordination
  • Patient Outreach
  • Electronic Medical Records
  • Behavioral Health
  • Medicaid Knowledge
  • Cultural Competency
  • Substance Use Recovery
  • Multi-disciplinary Teamwork
  • Social Determinants Of Health
  • Community Health

Posting details

Employment type
Full Time
Work arrangement
Hybrid
Experience
2-5 yrs
Salary
$27 - $32/hr
Location
Boston, Massachusetts
Posted
Jul 28, 2026
Application
Employer website
CC

Hiring organization

Community Care Cooperative

Community Care Cooperative (C3) exists to deliver great health care to all by offering a series of health plans uniquely tailored to meet each individual’s medical needs, no matter what road they are on in their healthcare journey. We work hand-in-hand with our provider...

Salary listed on 3 jobs
IndustryHospitals and Health Care
TypeNonprofit
Size201-500 employees
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Market context

Behavioral health roles remain active in Massachusetts

In Massachusetts, behavioral health employers often look for licensed or license-eligible clinicians with experience supporting at-risk youth and families, so demand tends to stay steady for candidates who can work across settings and age groups. These roles can be competitive because employers usually want a master’s degree, a clear licensure path, and practical experience; review the summarized requirements and benefits here, which are AI-summarized from the original job description to save research time, then confirm your licensure status and tailor your application to youth and family work.

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