Health Home Care Navigator

Sea Mar Community Health Centers; Aberdeen (WA); Hybrid; USD 34,000 - 41,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Prescription coverage

Life Insurance

Long Term Disability

EAP

PTO 24 days + 10 holidays

401(k)

Job summary

Sea Mar Community Health Centers is seeking an Integration Specialist to deliver Health Home services and care coordination for patients with complex medical and social needs. You will meet patients in homes, communities, or clinics, assess needs, and connect them with internal Sea Mar and community resources.

You will create a Health Action Plan with actionable steps, monitor progress, and collaborate with Care Management RNs and other specialists to support patient self-management and improved

Qualifications

• BSW or BA/BS in Human Services, Health Sciences or related field with experience in social services/care coordination.
• Two years relatable experience acceptable with approval by contractors/state certifications.
• Must obtain WA Health Homes Care Coordinator certification if required.
• CPR/Basic Life Support within 90 days of hire and maintained thereafter.

Responsibilities

• Reviews screenings and coordinates with service providers to support patient goals.
• Creates and monitors Health Action Plan (HAP) with patient, including long- and short-term goals.
• Provides six core Health Home services: health promotion, care coordination, and care management.
• Maintains active communication with care team and documents interactions daily.
• Works with patients in homes, communities, or clinics to support self-management.

Skills

Care coordination

Interdisciplinary teamwork

Motivational interviewing

Cultural competence

Education

BSW/BA in Human Services or related field

Tools

EMR systems

MS Office

Job description

Sea Mar Community Health Centers is seeking an Integration Specialist to deliver Health Home services and care coordination for patients with complex medical and social needs. You will meet patients in homes, communities, or clinics, assess needs, and connect them with internal Sea Mar and community resources.

You will create a Health Action Plan with actionable steps, monitor progress, and collaborate with Care Management RNs and other specialists to support patient self-management and improved