Community Care Navigator

Vista Community Clinic; Vista (CA); On-site; USD 34,000 - 36,000; Full time

Benefits offered by this job

Competitive compensation & benefits

Medical, dental, vision

Company-paid life insurance

Flexible spending accounts

403(b) retirement plan

Job summary

Vista Community Clinic (VCC) in Vista, CA is seeking an ECM Care Coordinator to join our multi‑disciplinary team. You will coordinate care for assigned health plan members and families, arranging ECM and Community Supports to improve health outcomes and address social determinants of health.

You will develop individualized care plans, coach patients using motivational interviewing, and serve as the main contact for patients and families throughout care transitions.

Qualifications

• Bachelor’s degree in social work, psychology, counseling, or behavioral science.
• Two years’ experience in a healthcare setting or with patient education and advocacy.
• Resourceful community liaison navigating through complex health systems and community services.
• Bilingual English/Spanish.

Responsibilities

• Coordinate ECM and Community Supports with the care team and ECM Members and/or family.
• Develop individualized care plans integrating clinical and non‑clinical needs to achieve health goals.
• Coach patients and caregivers using motivational interviewing and trauma‑informed language.
• Act as point of contact for patients and families throughout the care team.
• Identify referrals for social services addressing housing instability and SDOH.
• Visit patients at home or in their community settings for assessments and support.
• Monitor medication adherence with ECM RN Clinical Consultant.
• Perform population management tasks: scheduling, recalls, referrals, and portal callbacks.

Skills

Bilingual English/Spanish

Community liaison

Education

Bachelor’s degree in social work, psychology, counseling, behavioral science

Job description

Vista Community Clinic (VCC) in Vista, CA is seeking an ECM Care Coordinator to join our multi‑disciplinary team. You will coordinate care for assigned health plan members and families, arranging ECM and Community Supports to improve health outcomes and address social determinants of health.

You will develop individualized care plans, coach patients using motivational interviewing, and serve as the main contact for patients and families throughout care transitions.