Health Navigator

Integrated Services for Behavioral Health; Lancaster (AZ); On-site; USD 32,000 - 36,000; Full time

Job summary

Fairfield Community Health Center is seeking a Health Navigator to support PCMH and HRSA program requirements by ensuring coordinated, comprehensive, culturally responsive, and patient-centered care. The role focuses on access to care, continuity, population health management, and quality improvement.

Responsibilities include facilitating access, coordinating referrals, providing navigation and scheduling support, and liaising among patients, families, providers, and community partners.

Qualifications

• High school diploma or GED required.
• Graduate of a Medical Assistant program; LPN required.
• CCHW credential preferred, or willingness to obtain certification within a timeframe.
• Minimum of one year of ambulatory primary care or related healthcare office experience; FQHC experience preferred.

Responsibilities

• Facilitate timely access to primary and preventive care services.
• Coordinate referrals, transportation, hospital/ED discharges, and follow-up appointments.
• Provide enabling services to reduce barriers to care and support patients before, during, and after visits.
• Serve as a liaison between patients, families, providers, care teams and community partners.
• Participate in daily huddles, interdisciplinary care team meetings, and panel reviews.
• Communicate care gaps, risks, and social barriers to providers and leadership.

Skills

Teamwork

Azara

Time management

Customer service

Interpersonal skills

Education

High school diploma or GED

Medical Assistant program graduate

Licensed Practical Nurse (LPN)

Certified Community Health Worker (CCHW) credential preferred

Tools

Azara DRVS

EMR systems

Microsoft Office

Job description

We are seeking a Health Navigator!
Fairfield Community Health Center, Lancaster, Ohio

Join our Team!

Fairfield Community Health Center's (FCHC) goal is high-quality, better care for our patients. We have been recognized as a Level 3 Patient-Centered Medical Home (PCMH) by the National Committee for Quality Assurance for all our family practice offices. PCMH means we offer a team approach, with the patient as the most important member of the team. FCHC offers improved access to care with extended hours, as well as same-day and next-day appointments. We work with specialists and hospitals to coordinate care to be sure that the entire healthcare team is working together to assure the best possible health for our patients.

The pay range for this position is $23.00-$26.00/hr based on experience, education, and/or licensure.

Position Summary:

The Health Navigator role supports the organization's Patient-Centered Medical Home (PCMH) and HRSA Health Center Program requirements by ensuring coordinated, comprehensive, culturally responsive, and patient-centered care. This role advances access to care, continuity, population health management, community integration, quality improvement, and compliance with HRSA, NCQA, and other regulatory standards.

Primary duties and responsibilities:

• Facilitate timely access to primary and preventive care services

• Coordinate referrals, transportation, hospital/ED discharges, and follow-up appointments

• Provide enabling services to reduce barriers to care (e.g., navigation, scheduling support). Support patients before, during, and after visits to improve engagement and continuity. Assist in special outreach projects

• Serve as a liaison between patients, families, providers, care teams, and community partners

• Participate in daily huddles, interdisciplinary care team meetings, and panel reviews

• Communicate identified care gaps, risks, and social barriers to providers and leadership. Serve as a resource to providers and staff related to care coordination, population health workflows, and HRSA expectations

• Promote shared decision-making, health literacy, and self-management using motivational interviewing

• Provide ongoing follow-up, coaching, accountability, and advocacy

• Manage patient panels, registries, and risk stratification using Azara DRVS; review preventive services, labs, immunizations, utilization, and chronic disease measures

• Conduct patient outreach directly or coordinate outreach based on registry and panel data; monitor population-level trends and recommend interventions to improve outcomes and equity

• Maintain current knowledge of community-based organizations and external resources; link patients to social support, including food access, housing resources, insurance assistance, and transportation

• Participate in Quality Improvement (QI) activities aligned with PCMH and HRSA expectations

• Assist with development, tracking, and implementation of QI goals and action plans

• Track progress on preventive care, chronic disease outcomes, population health initiatives, and patient engagement

• Provide education and support to staff and patients related to QI initiatives

• Document all patient care and interactions (including phone calls and outreach) in the EMR per policy

• Report to work as scheduled and perform duties as assigned

• Serve as lead or support for special projects related to PCMH, HRSA, or population health

• Participate in internal committees and QI workgroups as requested

Competencies/Skills:

• Ability to work in a team environment

• Azara

• Recognizes and participates in continuous quality improvement efforts for operational and workflow changes.

• Demonstrates strong interpersonal, organizational, and customer service skills. Demonstrates computer proficiency and ability to work with all Microsoft Office applications, incident tracking software, and other pertinent organizational software applications.

• Demonstrates effective time management skills and ability to prioritize to meet operational demands.

• Applies professionalism to all interactions with health center patients, employees, providers, contractors, and vendors.

• Continually willing to learn, embrace change, and have a positive attitude.

• Demonstrates understanding of the importance of patient confidentiality.

• Ability to work independently and in a team environment.

• Demonstrates dependability through good attendance and punctuality.

• Demonstrates knowledge of Population Health Management, Patient-Centered Medical Home Concepts (PCMH), CPC, and JDS. And HEDIS.

Experience, education/training and licensure:

• High school diploma or GED required.

• Graduate of a Medical Assistant program; Licensed Practical Nurse (LPN) required.

• Certified Community Health Worker (CCHW) credential preferred, or willingness to obtain certification within an established timeframe.

• Minimum of one (1) year of experience in an ambulatory primary care, community health, or related healthcare office setting required; Federally Qualified Health Center (FQHC) experience preferred.

PHYSICAL REQUIREMENTS & ENVIRONMENTAL CONDITIONS:

Must be able to push, pull, and assist in lifting up to 25 lbs. May be exposed to loud noises. Must be able to stand and sit for extended periods, stoop, bend, reach, show manual dexterity, and clearly communicate with office personnel and external customers. May be exposed to blood and bodily fluids.

Enjoy a great work environment with an excellent salary, generous paid time off, and a strong benefits package.

To learn more about our organization: www.FCHC.org

OUR MISSION

To Strengthen our Community by Caring for You.

OUR VALUES

Together we RISE:
Respect
Integrity
Stewardship
Excellence

This job description is intended to indicate the basic nature of the position(s) allocated to this class and examples of typical duties that may be assigned. It does not imply that all positions within this class will perform all of the duties listed, nor does it attempt to list all possible duties that may be assigned.

We’re an equal opportunity employer. All applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.