Community Health Navigator Sonoma, California

MedZed; California; Remote; USD 45,000 - 70,000; Full time

Job summary

Join a forward-thinking company dedicated to improving health outcomes for vulnerable populations in California. As a Community Health Navigator, you will play a crucial role in coordinating care and services, empowering individuals to overcome barriers to health. This remote position offers the opportunity to make a significant impact on the lives of those facing challenges such as homelessness and mental health issues. Ideal candidates will possess strong interpersonal skills and a passion for community engagement. If you are looking to thrive in a dynamic environment and contribute to meaningful change, this role is perfect for you.

Qualifications

• Experience in care planning and case management.
• Understanding of patient-centered care principles.
• Ability to work with vulnerable populations.

Responsibilities

• Manage caseloads of members with complex needs.
• Create personalized care plans to address needs.
• Collaborate with healthcare teams and community agencies.

Skills

Interpersonal Skills

Community Relationship-Building

Problem-Solving

Critical Thinking

Collaboration Skills

Bilingual in Spanish

Understanding of Patient-Centered Care

Knowledge of Local Community Resources

Education

Bachelor’s degree in social work

Master’s degree/MSW

Tools

Microsoft Office Suite

Job description

Community Health Navigator

Location: Sonoma, California

Summary

Join MedZed, an innovative ECM provider, as we strive to "Inspire and Enable Better Health" for Californians. Our Community Health Navigators (CHN) are frontline, field-based team members working to impact the health and well-being of CalAim populations in their local markets. This remote, community-facing role involves coordinating services with members, providers, and community agencies to improve care and outcomes, especially for vulnerable populations including those experiencing homelessness, mental health issues, substance use disorders, and more. Ideal candidates possess strong interpersonal skills, community relationship-building abilities, and report to a local/regional Program Manager.

Daily Responsibilities

1. Manage caseloads of members with complex medical, social, and psychosocial needs.
2. Effectively communicate with members, caregivers, and families in person and remotely to foster supportive relationships.
3. Participate in case management activities such as clinical rounds, consultations, and team huddles.
4. Empower members and families to overcome barriers and improve health outcomes.
5. Serve vulnerable populations including homeless individuals, those with mental illnesses, substance use disorders, and others at risk.
6. Conduct member assessments (safety, health needs, psychosocial needs).
7. Create personalized care plans to address identified needs.
8. Assist with service coordination, including scheduling, transportation, and referrals.
9. Collaborate with healthcare teams, hospitals, community agencies, and social services.
10. Support discharge planning and post-discharge follow-up, including hospital collaboration.
11. Accompany members to health appointments as needed (no transportation required).
12. Maintain accurate, timely documentation in our care management system.
13. Perform other duties as assigned.

Qualifications

• Understanding of patient-centered care principles.
• Experience in care planning, case management, and caseload management.
• Experience working with vulnerable and diverse populations.
• Knowledge of local community resources.
• Ability to maintain professional boundaries.
• Basic understanding of therapeutic services (physical, occupational, speech, behavioral therapy, etc.).
• Knowledge of referral and authorization processes across organizations.
• Ability to build rapport and trust quickly.
• Strong problem-solving, critical thinking, and collaboration skills.
• Experience with clinical rounds and multidisciplinary teams.
• Ability to identify mental health, substance use, and medical concerns.
• Experience with pediatric populations is a plus, including knowledge of IEPs, 504 plans, and related programs.
• Ability to thrive in a fast-paced, evolving environment.
• Compliance with HIPAA standards.
• Proficiency in Microsoft Office Suite.
• Valid Driver’s License and access to insured, reliable vehicle.
• Bilingual in Spanish preferred.

Education & Work Experience

• Bachelor’s degree in social work, psychology, sociology, or public health (Master’s degree/MSW preferred).
• At least 2 years’ experience in medical, mental health, social, or community services.
• Minimum 1 year of experience working with children and youth aged 0-21, if applicable.