Integrated Care Navigator — Behavioral Health

Family Health Center of Worcester, Inc.; Vincennes (IN); On-site; USD 42,000 - 64,000; Full time

Job summary

Family Health Center of Worcester, Inc. is seeking a Care Coordinator to connect behavioral health services, substance use treatment, primary care, and community resources for coordinated, patient-centered care in Vincennes, Indiana.

You will work with internal care teams and community partners to support safe transitions and ongoing engagement in care. The role involves coordinating across systems, addressing barriers such as transportation, housing, and access to benefits, with a focus on

Qualifications

• 1-3 years of experience in behavioral health, case management, or care coordination preferred.
• Experience working with high-risk or underserved populations preferred.

Responsibilities

• Perform routine referral, linkage, coordination, and monitoring of care across service providers.
• Facilitate transitions through warm handoffs between levels of care.
• Monitor and support follow-up activities with treatment or service providers to track client engagement in care.
• Coordinate care by referring to and communicating with external healthcare providers utilized by the client.
• Ensure every individual engaged in care is engaged with a primary care provider.
• Contribute to the development and updating of person-centered treatment/care plans.
• Identify barriers to care and address social determinants (housing, transportation, food insecurity).
• Build rapport and support engagement in treatment.
• Assist individuals receiving services with accessing benefits and waivers.
• Support development and implementation of safety plans.
• Coordinate with crisis teams and emergency services when needed.
• Ensure timely follow-up after ER visits or hospitalizations.
• Track admissions/discharges to other facilities and continuity of care.
• Track other services provided by outside entities.
• Reduce Readmissions through proactive outreach.
• Complete timely, accurate documentation in the EHR.
• Participating in interdisciplinary team meetings.
• Communicate effectively with clinicians, case managers, prescribers, and external partners.
• Coordinate care provision with community agencies in support of the client.
• Ensure language-accessible care.

Skills

Rapport building

Time management

Professional growth

Integrated care models

Trauma-informed care

Mental health knowledge

Communication skills

Caseload management

Cultural competence

Patient-centered approach

Education

High School Diploma or GED

Job description

Family Health Center of Worcester, Inc. is seeking a Care Coordinator to connect behavioral health services, substance use treatment, primary care, and community resources for coordinated, patient-centered care in Vincennes, Indiana.

You will work with internal care teams and community partners to support safe transitions and ongoing engagement in care. The role involves coordinating across systems, addressing barriers such as transportation, housing, and access to benefits, with a focus on