Community Health Navigator - Home-Based Care

Cityblock Health; Fayetteville (NC); On-site; USD 78,512,000 - 100,576,000; Full time

Benefits offered by this job

Health insurance

Life insurance

Retirement benefits

Equity program

Paid time off

Job summary

Cityblock Health seeks an experienced Community Health Partner to support integrated care for members with complex needs. You will collaborate with RN Care Managers, manage caseloads, and help address social determinants of health in community settings.

The role includes conducting behavioral health screenings and coordinating referrals to community resources. The position emphasizes advocacy for members, strong communication, and the ability to work cross-functionally with care teams in a

Qualifications

• 2+ years of progressive experience in care coordination, community health, health promotion, or a related field.
• Strong problem-solving and judgment; know when to escalate clinical concerns.
• Excellent written, verbal, and presentation communication; experience with documentation.

Responsibilities

• Collaborate with RN Care Managers to support members with complex medical and behavioral health needs.
• Manage a caseload of members, identifying and addressing social, behavioral, and environmental barriers to health.
• Develop and implement care plans with members, addressing social needs and supporting care goals.
• Conduct assessments (PHQ-9, GAD-7, AUDIT, DAST-10) and refer to behavioral health programs as needed.
• Support members in scheduling and attending provider appointments, labs, and referrals to community resources.
• Meet members in community settings (home, shelter, hospital) as needed to support the care team.
• Document interactions and tasks using care facilitation and scheduling platforms.

Job description

Cityblock Health seeks an experienced Community Health Partner to support integrated care for members with complex needs. You will collaborate with RN Care Managers, manage caseloads, and help address social determinants of health in community settings.

The role includes conducting behavioral health screenings and coordinating referrals to community resources. The position emphasizes advocacy for members, strong communication, and the ability to work cross-functionally with care teams in a