Field-Based Community Health Navigator

DeKalb Health; Tishomingo (OK); On-site; USD 30,000 - 42,000; Full time

Benefits offered by this job

Great Pay

Healthcare

401k

Job summary

The Family Health Center of Southern Oklahoma is seeking a Community Health Worker for the Tishomingo location to serve patients and community partners. The CHW will screen for social needs, facilitate referrals, and support care coordination with the FQHC care team.

You will work with physicians, nurses, social workers, and case managers to address social drivers of health, promote health equity, and track referral outcomes for HRSA reporting. Travel may be required to visit community sites.

Qualifications

• High school diploma or equivalent required; Associate's or Bachelor's degree preferred in public health, social work, or related field.
• Within the first year, obtain CHW certification or after 1,000 working hours, whichever comes first.
• Experience in community health, social services, or primary care/FQHC settings preferred.
• Strong knowledge of local community resources, social service systems, and public health programs.
• Excellent communication, interpersonal, and organizational skills.
• Ability to work effectively with diverse, underserved populations and demonstrate cultural humility.

Responsibilities

• Screen patients for Health-Related Social Needs (HRSN) and document findings in the EHR.
• Provide referrals to internal services and external community organizations; assist with program enrollment.
• Conduct closed-loop referral follow-up and support care transitions, medication adherence, and transportation coordination.
• Collaborate with care managers, behavioral health, social workers, and providers on patient-centered plans.
• Track referral outcomes and assist with HRSA reporting requirements for program improvement.
• Develop partnerships with community organizations and participate in community outreach initiatives.

Skills

Communication skills

Interpersonal skills

Organizational skills

Cultural humility

Bilingual (Spanish)

Education

High school diploma or equivalent

Associate's or Bachelor's degree in public health or related field

Tools

Electronic Health Records (EHR) systems

Job description

The Family Health Center of Southern Oklahoma is seeking a Community Health Worker for the Tishomingo location to serve patients and community partners. The CHW will screen for social needs, facilitate referrals, and support care coordination with the FQHC care team.

You will work with physicians, nurses, social workers, and case managers to address social drivers of health, promote health equity, and track referral outcomes for HRSA reporting. Travel may be required to visit community sites.