Health Home Integration Specialist

Sea Mar; Aberdeen (WA); Hybrid; USD 48,000 - 65,000; Full time

Job summary

Sea Mar Community Health Centers is seeking an Integration Specialist to provide Health Home services and care coordination for patients with complex medical and behavioral health needs. The role involves meeting patients at their chosen location, conducting screenings, and developing a Health Action Plan with actionable steps to improve self-management.

The position requires collaboration within an interdisciplinary team, strong communication, and a commitment to culturally aware care.

Qualifications

• Bilingual English/Spanish preferred.
• Excellent communication with patients, families, and colleagues.
• Experience working with interdisciplinary care teams and care coordination.

Responsibilities

• Review screenings and coordinate with service providers to support patient goals.
• Create Health Action Plans with long- and short-term goals and steps.
• Provide six core Health Home services: health promotion, care coordination, referrals, and patient support.
• Document daily interactions in the scheduling and health records systems.
• Collaborate with care management team and behavioral health providers as needed.

Skills

Bilingual English/Spanish (preferred)

Communication skills

Interdisciplinary teamwork

Education

BSW or BA/BS in Human Services/Health Sciences

Tools

Electronic Health Records (EHR)

Microsoft Office

Job description

Sea Mar Community Health Centers is seeking an Integration Specialist to provide Health Home services and care coordination for patients with complex medical and behavioral health needs. The role involves meeting patients at their chosen location, conducting screenings, and developing a Health Action Plan with actionable steps to improve self-management.

The position requires collaboration within an interdisciplinary team, strong communication, and a commitment to culturally aware care.