SDOH Health Population Navigator - QIP - FULL-TIME DAYS (25454)

Job Duties

• Communicates with patient Care Team members (physicians, behavioral health team and/or other health care providers) to provide patient with integrative care.
• Carrries out tasks to execute the medical and support service plans including but not limited to guiding patients to appointments and accompanying them when necessary.
• Acts as the primary liaison with medical providers to ensure patient adherence to care.
• Tracks patient attendance for medical appointments, initiates outreach as well as adhering to missed appointment procedures.
• Coordinates treatment plan adherence.
• Coordinates deliverables per HORIZON ISC program.
• Maintains program database of community partners and referrals.
• Maintains documentation of all patient encounters and completes reporting requirements according to organizational and contractual requirements.
• Maintains strict confidentiality in accordance with state and agency policies.
• Attends and represents the organization at professional conferences, in-service training, and meetings at the request of or with the approval of supervisor.
• Flexibility with covering weekend/evening shifts.

Requirements

• Experience working as a Community Health Worker, care coordinator, or patient navigator serving complex or vulnerable populations.
• Strong knowledge of SDOH, including housing instability, food insecurity, transportation barriers, benefits access, and other non-clinical drivers of health.
• Demonstrated experience with community-based referrals and resource navigation, including follow-up to ensure successful connections (closed-loop referrals).
• Familiarity with community-based organizations, county social services, and benefit systems.
• Strong communication, engagement, and documentation skills, particularly in interdisciplinary care settings.
• Experience working in healthcare, social services, or community-based settings, preferably within a safety-net or Medicaid-focused environment.

Qualifications

• Excellent communication and interpersonal skills.
• Experience working with behavioral health and/or substance use population.
• Experience working in a medical or social services environment preferred.
• Strong attention to detail.
• Proficient with computer databases.
• Analytical problem-solving skills.
• Ability to manage time, prioritize, and meet deadlines.
• Ability to work independently and as a team member.
• Good attitude, professionalism, promote team attitude.
• Proficiency in Spanish preferred.

Core Competencies & Experience Needed

• Bachelor's Degree in behavioral health field required.
• Master's Degree in behavioral health field preferred.

Pay

Salary Commensurate With Experience Within Posted Range $47,000-$60,000/Year

Benefits

• A comprehensive benefits package, including a competitive medical, dental, and vision plans.
• A generous time off policy that includes ample vacation days, personal time, sick leave and nine paid holidays.
• A commitment to the personal and professional growth of our employees, offering robust tuition reimbursement and continuing education programs to help support our employees ongoing development.