Community Health Navigator - Rural Health Transformation Program

Arthur Center Community Health

Mexico (MO)

On-site

USD 52,000 - 72,000

Full time

12 days ago

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Benefits offered by this job

Medical (HSA option)

Dental

Vision

Life insurance

401(k) with up to 6% company match

9 paid holidays

Generous PTO

Job summary

Arthur Center is seeking a dedicated RHTP Navigator to serve rural Audrain, Callaway, and Montgomery Counties. You will conduct needs screenings, manage referrals, remove barriers to care, and follow up until services are completed, collaborating with hospitals, FQHCs, behavioral health providers, pharmacies, EMS, schools, and public health agencies.

The role emphasizes relationship-building, field-based follow-through, and a mission-driven workplace culture within Missouri’s rural health

Qualifications

Bachelor’s degree in Social Work, Public Health, Human Services, Psychology, or related field required.
Master’s degree in Social Work or related behavioral health or human services field preferred.
Experience in community health work, care coordination, patient navigation, Medicaid care management, or related field.

Responsibilities

Screening, intake, and referral management across HUB partners and providers.
Engage Medicaid members and high-need residents through calls, visits, and outreach.
Identify and resolve barriers to care, including transportation, insurance, and digital access; escalate when needed.
Maintain community presence, participate in hub huddles, and track outreach and outcomes.

Skills

Relationship-building

Communication

Problem-solving

Organizational skills

Field-based independence

Cultural competency

Bilingual skills

Education

Bachelor’s degree in Social Work/Public Health/Human Services/Psychology or related field

Master’s degree in Social Work or related field preferred

Tools

CIE (Community Information Exchange)

Case management platforms

Job description

Department: Rural Health Transformation Program
Location: Audrain, Callaway, and Montgomery Counties
Reports To: Director of Rural Health Transformation
Job Type: Full-time | Monday - Friday, 8:00 AM - 5:00 PM (occasional evenings or weekends as needed)
Travel: Frequent local travel throughout assigned Hub geography expected most days

POSITION SUMMARY

Arthur Center is looking for a dedicated, community-rooted RHTP Navigator to serve as a frontline member of our Local Community Hub under Missouri's Transformation of Rural Community Health Care (ToRCH Care) model. In this role, you will work directly with rural residents in Audrain, Callaway, and Montgomery Counties conducting needs screenings, managing referrals, removing barriers to care, and following up until services are completed. You will work across hospitals, FQHCs, behavioral health providers, pharmacies, EMS, schools, local public health agencies, and community organizations to help residents connect to and follow through on clinical, behavioral, and social services they need. This is active, relationship-driven, community-based work that requires strong follow-through, genuine care for people, and the persistence to keep showing up. If you find value in making real connections in your community and helping people navigate complex systems with dignity, we want to hear from you.

THE RHTP NAVIGATOR POSITION OFFERS

Meaningful, community-based work as part of a statewide rural health transformation initiative
Competitive pay commensurate with experience | Benefits Eligible
Comprehensive benefits package including Medical (HSA option), Dental, Vision, Life insurance, and 401(k) with up to 6% company match
9 paid holidays plus generous PTO
A mission-driven workplace culture committed to making quality care accessible for rural Missourians

Key Tasks And Responsibilities

SCREENING, INTAKE AND REFERRAL MANAGEMENT

Conduct standardized screening and intake to identify clinical, behavioral, and social needs for residents served by the Hub.
Manage closed-loop referrals and warm handoffs across Hub partners including hospitals, FQHCs, behavioral health providers, pharmacies, EMS, local public health agencies, schools, and community organizations.
Confirm service receipt, document outcomes, and re-engage residents when referrals or services are not completed.
Document all screenings, referrals, and follow-up activity accurately in the Community Information Exchange (CIE) and other Hub-approved systems.

RESIDENT ENGAGEMENT AND CARE NAVIGATION

Engage Medicaid members, dually eligible residents, and other high-need residents through calls, field visits, community outreach, and partner-site follow-up.
Help residents access Hub-supported services including primary care, behavioral health, women's health and prenatal care, EPSDT services, chronic disease management, healthy homes services, home visiting, pharmacy-based services, telehealth, and non-emergency medical transportation.
Provide health education, care navigation, and reinforcement of care plans to support resident engagement and follow-through.
Maintain an assigned caseload with structured follow-up until services are completed, needs are resolved, or care is appropriately transitioned.

BARRIER RESOLUTION AND ESCALATION

Identify, prioritize, and resolve barriers to care including appointment scheduling, transportation, medication access, benefits and insurance issues, food and nutrition supports, and digital-access barriers.
Escalate recurring or complex barriers to the Hub Program Manager for review or broader workflow changes.
Escalate urgent clinical, behavioral health, or safety concerns to licensed staff or supervisors according to established Hub protocols.
Implement re-engagement strategies including multi-channel outreach and partner coordination for residents who are difficult to reach or who do not complete referred services.

COMMUNITY PRESENCE AND HUB COLLABORATION

Maintain a visible presence in the community through outreach activities, partner site engagement, and local events to build awareness of Hub services and resident trust.
Actively contribute to Hub huddles, case reviews, and partner meetings; support provider coordination and share frontline insights to improve referral pathways and workflows.
Track and report outreach, screening, referral, and outcome data required by the Hub, Regional Care Network (RCN), and Rural Health Transformation Office (RHTO).
Perform other duties as assigned.

SKILLS AND ATTRIBUTES

Commitment to serving rural communities and high-need populations with dignity and respect.
Strong relationship-building skills. Able to earn and maintain trust with residents, families, providers, and community organizations.
Practical problem-solver who can identify barriers and connect people to the right resources efficiently.
Highly organized with the ability to manage multiple active cases and maintain consistent, structured follow-up.
Persistent and dependable. Takes ownership of referrals and follows through until services are completed.
Comfortable working independently in field-based, community settings including homes, clinics, schools, and partner sites.
Clear, effective communicator across diverse settings and audiences.
Able to follow standardized workflows and documentation requirements while adapting approach to individual and community needs.

REQUIRED QUALIFICATIONS

Bachelor's degree in Social Work, Public Health, Human Services, Psychology, or a related field required.
Master's degree in Social Work or a related behavioral health or human services field preferred.
Relevant experience in community health work, care coordination, case management, patient navigation, Medicaid care management, behavioral health support, public health outreach, social services, or a related field.
Demonstrated experience working directly with rural communities and/or high-need populations facing barriers such as transportation, food insecurity, housing instability, limited digital access, or fragmented services.
Experience conducting resident, client, or patient intake and needs screening and following referrals through to completion.
Valid driver's license and ability to travel routinely throughout Audrain County and the assigned Hub service area.
Ability to accurately document and track activities using digital systems such as CIE, EHR, or case management platforms.

PREFERRED QUALIFICATIONS

Formal Community Health Worker (CHW) training or certification, or post‑secondary education in community health, public health, social services, behavioral health, or a related field.
Experience using a Community Information Exchange (CIE) or other closed-loop referral platform.
Experience in settings central to the Hub model such as an FQHC, Rural Health Clinic, Critical Access Hospital, behavioral health agency, local public health agency, EMS/community paramedicine, school-based health, or community-based organization.
Experience serving Medicaid members, dual‑eligible residents, maternal and child populations, individuals with chronic disease, behavioral health populations, or people with substance use disorder.
Training or experience in motivational interviewing, trauma‑informed care, health coaching, benefits navigation, Mental Health First Aid, or other community‑based behavioral health support approaches.
Bilingual skills or demonstrated effectiveness serving culturally and geographically diverse rural communities.

ABOUT US

At the Arthur Center, we inspire community health and wellness by meeting people where they are and supporting whole‑person well‑being. Our mission is to empower individuals and families to build healthier, more fulfilling lives so they can invest their time, talents, and resources into truly living.

As a Federally Qualified Health Center (FQHC) and Certified Community Behavioral Health Organization (CCBHO), our impact is driven by over 200 dedicated staff members who deliver integrated primary care, behavioral health, and dental services across Audrain, Callaway, Montgomery, Pike, Ralls, and Monroe Counties. Arthur Center is proud to serve as a Local Community Hub Anchor within the ToRCH Care Network, working alongside regional partners to transform how rural Missourians access and experience care.

PROGRAM FUNDING DISCLOSURE

This position is part of Missouri's Rural Health Transformation Program (RHTP), supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award. The contents of this posting represent the views of Arthur Center and do not necessarily represent the official views of, nor an endorsement by, CMS/HHS or the U.S. Government.

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