Community-Based Rural Health Navigator

Lake Regional Health System; Osage Beach (MO); Sur place; USD 42 000 - 68 000; Plein temps

Résumé du poste

Lake Regional Health System in Osage Beach, MO seeks a RHTP Navigator to join the local hub team and coordinate community-based health and social services. You will screen, refer, and track residents’ needs using the CIE and Hub systems, ensuring barriers are addressed and care plans are followed.

The role involves frequent travel within the assigned Hub geography, non-clinical duties, and collaboration with hospitals, FQHCs/RHCs, EMS, public health, schools, and community organizations to

Qualifications

• High school diploma or equivalent and relevant experience in community health work, care coordination, case management, patient navigation, Medicaid care management, public health outreach, social services, or a related field
• Ability to manage multiple active cases and maintain organized follow-up across residents and partners
• Strong verbal and written communication skills and the ability to build trust with patients, families, providers, and community organizations
• Experience documenting activities using digital systems (e.g., CIE, EHR, or case management tools)

Responsabilités

• Conduct standardized screening and intake to identify clinical, behavioral, and social needs; document findings, referrals, and follow-up in the Community Information Exchange (CIE) and other Hub-approved systems
• Manage closed-loop referrals and warm handoffs across Hub partners; confirm service receipt, document outcomes, and re-engage residents when referrals or services are not completed
• Engage Medicaid members, dually eligible residents, and other high-need residents through calls, field visits, community outreach, and partner-site follow-up; provide health education, care navigation, and reinforcement of care plans
• Help residents access Hub-supported services such as primary care, behavioral health, women’s health and prenatal care, EPSDT, chronic disease management, healthy homes, home visiting, pharmacy-based services, telehealth, and non-emergency medical transportation
• Identify, prioritize, and resolve barriers to care; escalate as needed for Hub Program Manager review or workflow changes
• Own an assigned caseload and maintain structured follow-up until services are completed or appropriately transitioned
• Actively contribute to Hub huddles, case reviews, and partner meetings; support provider coordination and inform improvements
• Track and report outreach, screening, referral, and outcome data as required by Hub, RCN, and RHTO
• Escalate urgent clinical, behavioral health, or safety concerns to licensed staff or supervisors
• Implement re-engagement strategies for residents who are difficult to reach or do not complete referred services
• Maintain a visible presence in the community through outreach and events to build awareness of Hub services
• Other duties as assigned

Description du poste

Lake Regional Health System in Osage Beach, MO seeks a RHTP Navigator to join the local hub team and coordinate community-based health and social services. You will screen, refer, and track residents’ needs using the CIE and Hub systems, ensuring barriers are addressed and care plans are followed.

The role involves frequent travel within the assigned Hub geography, non-clinical duties, and collaboration with hospitals, FQHCs/RHCs, EMS, public health, schools, and community organizations to