Community Health Navigator: Home Visits & Care Coordination

Care New England; Warwick (RI); On-site; USD 42,000 - 64,000; Full time

Job summary

Care New England is seeking a Community Health Worker to join the home-based care team. You will support patients facing complex medical and social challenges by linking them to community resources, coordinating care, and providing ongoing navigation and support.

You will visit patients in their homes and communities, applying culturally sensitive health information to improve health literacy and empower self-management, while collaborating with the primary care team to meet patient goals.

Qualifications

• High School diploma required with a combination of training and skills to effectively carry out responsibilities.
• Must have Certification in Community Health Work or is working toward certification, must obtain certification within 12 months.
• Associates or Bachelor’s degree in Social Work, Community/Public Health or related health sciences field a plus.
• Experience working with primary care providers or in other healthcare settings.
• Experience working with patients regarding managing their health, navigating systems, providing care coordination and health coaching is preferred.
• The ability to travel to various locations in the state and reliable transportation is required.
• Must possess a valid, current state issued driver’s license, have reliable transportation and proof of current auto insurance required.
• Ability to speak a second language, Spanish preferred.

Responsibilities

• Used to assist the Integra In-Home patients in securing community resources identified through the SDOH screening and in-home assessment.
• Acting as a liaison between the patient and the community resource.
• Would be responsible for the SDOH screening and assessment of the patients needs to remain in the community.
• Assist with the management of the newly implemented chronic condition disease management programs for BCBS members.
• The Community Health Worker plays a critical role in assessing patient needs, offering community resources and referrals, providing navigation, support, care coordination, and ongoing case management to meet those needs.
• Visits patients in their homes and in the communities in which they live, providing culturally sensitive approaches to health information to improve health literacy.
• The Community Health Worker facilitates the patient’s decision-making and self-management to help patients engage in their overall health and achieve their health goals.
• This individual will be responsible for tracking patient related activities, monitoring and documenting progress.
• Works collaboratively with the primary care team to promote patient-centered care and actively participates in multidisciplinary patient-centered team meetings.
• The Community Health Worker has frequent contact with many community agencies on behalf of the patients served, networking and collaborating on resource identification to improve the overall health of the population.

Skills

Care coordination

Health navigation

Resource identification

Multidisciplinary collaboration

Spanish (bilingual)

Education

High School diploma

CHW certification in progress

Associates/Bachelor in Social Work/Public Health

Job description

Care New England is seeking a Community Health Worker to join the home-based care team. You will support patients facing complex medical and social challenges by linking them to community resources, coordinating care, and providing ongoing navigation and support.

You will visit patients in their homes and communities, applying culturally sensitive health information to improve health literacy and empower self-management, while collaborating with the primary care team to meet patient goals.