Impactful Community Health Navigator - Home Visits

Integra Community Care Network; Warwick (RI); On-site; USD 42,000 - 56,000; Full time

Job summary

Integra Community Care Network is seeking a Community Health Worker to join the care team in Rhode Island. You will support patients with complex health and social needs through home-based, community-focused interventions and sustained care coordination.

The role emphasizes SDOH screening, resource navigation, and collaboration with primary care teams to improve health outcomes and health literacy in diverse communities.

Qualifications

• High School diploma required with ability to carry out responsibilities.
• Certification in Community Health Work or in progress, must obtain within 12 months.
• Associate's or Bachelor's in Social Work, Community/Public Health or related field a plus.
• Experience with primary care or other healthcare settings.
• Experience with patient health management, navigation, care coordination and coaching preferred.
• Ability to travel within the state and reliable transportation.
• Valid driver's license, insurance, and transportation required.
• Ability to speak a second language, Spanish preferred.

Responsibilities

• Assist Integra In-Home patients in securing community resources identified through SDOH screening and in-home assessment.
• Act as liaison between patient and community resources.
• Perform SDOH screening and assessment of patient needs to remain in the community.
• Assist with management of chronic condition disease management programs for BCBS members.
• Provide navigation, support, care coordination and ongoing case management to meet patient needs.
• Visit patients in homes and communities, delivering culturally sensitive health information to improve health literacy.
• Facilitate patient decision-making and self-management to engage in health goals.
• Track patient activities, monitor and document progress.
• Collaborate with primary care team and participate in multidisciplinary patient-centered team meetings.
• Engage with community agencies to identify resources and improve population health.

Job description

Integra Community Care Network is seeking a Community Health Worker to join the care team in Rhode Island. You will support patients with complex health and social needs through home-based, community-focused interventions and sustained care coordination.

The role emphasizes SDOH screening, resource navigation, and collaboration with primary care teams to improve health outcomes and health literacy in diverse communities.