Care Navigator II: Chronic Care & Behavioral Health

Sea Mar Community Health Centers

Everson (WA)

On-site

USD 28,929 - 34,440

Full time

14 days+

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Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Life insurance

Long-term disability

Paid time off

Job summary

Sea Mar Community Health Centers seeks a Care Coordinator II to manage care for patients with chronic conditions and behavioral health needs at the Everson Medical Clinic. You will participate in daily huddles, identify patient needs, and provide point-of-care services to improve quality and patient-centered care.

The role requires strong organizational, communication, and confidentiality skills, with Spanish language fluency preferred.

Qualifications

Knowledge of the Patient-Centered Medical Home model and motivational interviewing is a plus.
Familiarity with evidence-based standards of care for chronic conditions and behavioral health.
Ability to document patient information in the Electronic Health Record.
Spanish language fluency is strongly preferred; other languages welcome.

Responsibilities

Participate in morning huddles to anticipate patients’ clinical, social and behavioral health needs.
Collaborate with the care team to identify gaps in care and implement process-improvement strategies.
Provide brief interventions at the point of care to manage chronic illnesses and link to behavioral health resources.
Advocate for patient services with community, social service, and medical providers.
Coordinate care transitions for patients discharged from hospitals, ERs or long-term care facilities.
Track adherence to the care plan and communicate outcomes to the primary care provider.
Lead quality improvement activities and organize monthly Health Home meetings.
Document performance and monitor sustainability of quality measures.