Integration Specialist (BA)

Sea Mar Community Health Centers

Anacortes (WA)

On-site

USD 31,684 - 42,705

Full time

14 days+

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Benefits offered by this job

Medical

Vision

Prescription coverage

Life Insurance

Long Term Disability

EAP

PTO 24 days + 10 holidays

401(k)

Job summary

Sea Mar Community Health Centers in Anacortes, WA, is seeking an Integration Specialist (BA) to deliver Health Home services within the Care Management team. This full‑time role emphasizes patient‑centered care, managing complex medical and social needs, and coordinating referrals to Sea Mar services and community resources.

The position requires a BA/BS in related fields and certifications; travel to clients’ homes or clinics is common, with home, clinic, and hospital settings as meeting

Qualifications

BSW or BA/BS in Human Services or related field with experience in social service case management or care coordination.
WA Health Homes Care Coordinator certification training within sixty days of hire.
Maintain state Health Homes Care Coordinator certification.
Complete agency and state mandatory trainings.

Responsibilities

Complete job responsibilities in client homes, community settings, or clinics.
Understand medical terminology related to chronic conditions.
Work with an interdisciplinary care team including medical providers and behavioral health staff.
Maintain independence while collaborating with team members.
Willingness to work with translators if not bilingual.
Carry a caseload of up to 60 patients as assigned.
Provide up to two contacts per month for high‑intensity patients.
Compute rate, ratios, and percent; interpret bar graphs.
Solve problems with limited standardization as needed.

Skills

Health Home

Care Management

Interdisciplinary teamwork

Communication

Education

BSW or BA/BS in Human Services or related field

WA State Health Homes Care Coordinator certification training

Basic Life Support (BLS) CPR within 90 days

Job description

Sea Mar Community Health Centers, a Federally Qualified Health Center (FQHC) founded in 1978, is a community‑based organization committed to providing quality, comprehensive health, human, housing, educational and cultural services to diverse communities, specializing in service to Latinos in Washington State. Sea Mar proudly serves all persons without regard to race, ethnicity, immigration status, gender, or sexual orientation, and regardless of ability to pay for services. Sea Mar's network of services includes more than 90 medical, dental, and behavioral health clinics and a wide variety of nutritional, social, and educational services.

Integration Specialist (BA) - Posting #27369

Hourly Rate: $26.52

Position Summary

Full‑time Integration Specialist position available for the Care Management department in Anacortes, WA. The Integration Specialist provides Health Home services and similar support for patients whose complex medical, behavioral health and social concerns impede their ability for self‑care. Must have knowledge of Community Outreach or Case Management. Knowledge of Community Resources preferred. Willingness to commute to meet with clients at various settings including client’s home, clinic and/or hospital.

The Integration Specialist is a member of the patient‑centered inter‑disciplinary Care Management team, and has a strong understanding of chronic conditions and how each condition can compound another, leading to poor health outcomes.

The Integration Specialist meets with patients in the location of their choice; their homes, in the community, at in‑patient settings or in clinics. This individual’s work will include timely and effective screenings and appropriate referrals to internal Sea Mar service providers, community‑based resources and emergency services when indicated.

Screenings may pertain to functional abilities, daily medical self‑management skills, fall risk, depression, anxiety, drug and alcohol use, and other screenings when indicated. Through the use of motivational interviewing and other techniques, the Integration Specialist will work with the patient to create a Health Action Plan which includes long and short term goals with actionable steps that will help the client self‑manage their chronic health conditions.

As part of ongoing services, the Integration Specialist will follow up with the patient regularly to evaluate progress made towards completing their Health Action Plan goals. As part of the Care Management/ Health Home six core services, the Integration Specialist provides care transition assistance from in‑patient settings, follow‑up in the home, as well as community based care coordination, health promotion, patient and family support, referral to community and social support services, and comprehensive care management. As part of the client’s interdisciplinary team, the Integration Specialist will provide information and recommendations regarding the client’s care. Must have experience working in the community with underserved populations required.

Responsibilities

Must be able to complete job responsibilities in various locations; client’s home setting, community setting, or clinic.
Ability to understand medical terminology pertaining to chronic conditions.
Ability to work with an interdisciplinary care team including medical providers, nursing staff, care coordinators, behavioral health and support staff.
Must be able to perform independently and at the same time perform effectively and professionally as an interdisciplinary team member.
Must be able/willing to work with translators if not bilingual.
May carry a caseload of 60 patients as assigned by Care Manager.
Provides up to two contacts per month for high‑intensity patients (one face‑to‑face contact and one telephone contact with patient, providers, or caregivers) with a step down to telephone contact when the patient has demonstrated stability.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

Education and/or Experience

BSW or BA/BS in Human Services, Health Sciences or related field with experience either in social service case management, or care coordination. Will consider other bachelor’s level applicants who have similar experience, but only in the circumstance when doing so is approved by contractors and/or state certification entities (ex: HCA approval of WA Health Home Program care coordinator status).
When contractually necessary for provision of work for which individual is hired, this person will complete WA State Health Homes Care Coordinator certification training within sixty days of hire.
Will acquire and maintain state Health Homes Care Coordinator certification.
Must complete agency and State mandatory trainings.
This position must obtain Basic Life Support (BLS) CPR within 90 days of hire date and is required to maintain current BLS CPR throughout employment.
Experience working with substance use disorders, chronic mental illness, and chronic medical conditions, and people in underserved and transient populations.
Background in community outreach or case management preferred.
Knowledge of Community Resources preferred.
Willingness to commute to meet with clients in various settings including in the client’s home, clinic, and/or hospital.

What We Offer

Sea Mar offers talented and motivated people the opportunity to work in a dynamic and growing community health organization. Working at Sea Mar Community Health Centers is more than just a job, it’s a fulfilling career with opportunity for advancement. The fringe benefits surpass most companies. For example, Full‑time employees working 30 hours more, receive an excellent benefit package of the following: