RHTP Health Navigator

Preferred-Family-Healthcare,-Inc.; Hannibal (MO); On-site; USD 40,000 - 58,000; Full time

Benefits offered by this job

Paid time off

Health, dental, vision, retirement, &/

Top-notch training

Career mobility

Welcoming, supportive culture

Job summary

Centerstone in Hannibal, MO seeks a Rural Health Transformation Program (RHTP) Navigator to support residents in navigating healthcare and social services. This frontline, non-clinical role coordinates referrals, documents activities, and promotes coordination across hospitals, clinics, and community partners.

You will help residents overcome barriers like transportation and housing, track outcomes in Hub systems, and escalate needs as required to ensure care plan adherence.

Qualifications

• High school diploma or equivalent.
• Experience in community health work or care coordination is preferred.
• Experience in rural or high-need populations is a plus.

Responsibilities

• Conduct screenings to identify clinical, behavioral health, and social service needs.
• Connect residents with appropriate healthcare providers and community resources.
• Initiate, manage, and track referrals through completion and document outcomes.
• Assist residents in overcoming barriers such as transportation, housing instability, and food insecurity.
• Coordinate care across healthcare providers, behavioral health organizations, and public health agencies.
• Follow up with residents to encourage engagement and service completion.

Skills

Care coordination

Case management

Patient navigation

Medicaid care management

Behavioral health support

Public health outreach

Social services

Field travel

Education

High school diploma or equivalent

Job description

Job Description:RHTP NavigatorCompany: CenterstoneLocation: Hannibal, MOShift: Full-time, Monday - FridayAbout the RoleThe Rural Health Transformation Program (RHTP) Navigator serves as a frontline, community-based team member within a Local Community Hub as part of Missouri's Transformation of Rural Community Health Care (ToRCH Care) model. Local Community Hubs are county-level care coordination entities that bring together hospitals, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), behavioral health providers, pharmacies, Emergency Medical Services (EMS), local public health agencies, and community-based organizations to better coordinate clinical, behavioral, and social care for rural residents.Reporting to the Hub Program Manager, the RHTP Navigator plays a vital role in helping individuals access the care and resources they need to improve their health and well-being. This position works directly with residents to identify barriers to care, conduct screenings, coordinate referrals, and support follow-through with clinical, behavioral health, and community-based services.As part of the Hub team, the Navigator helps residents successfully navigate healthcare and social service systems by connecting them with local resources, tracking referrals, and ensuring services are received. Using the Community Information Exchange (CIE) and other Hub systems, the Navigator documents screenings, monitors referral outcomes, and escalates unresolved needs when additional intervention is required.This position collaborates with hospitals, FQHCs, RHCs, behavioral health providers, pharmacies, EMS and community paramedicine teams, local public health agencies, schools, and community-based organizations to promote coordinated care and improve access to services. The Navigator also provides valuable frontline insight into recurring barriers and community needs, helping shape Hub operations and local service improvements over time.This is a non-clinical position. The RHTP Navigator does not diagnose, prescribe, or provide licensed clinical treatment. Instead, this role focuses on building relationships, encouraging engagement, supporting care plan adherence, and helping residents overcome challenges that may prevent them from receiving needed services. Any urgent medical, behavioral health, or safety concerns are escalated according to established Hub protocols.What You'll DoConduct screenings to identify clinical, behavioral health, and social service needsConnect residents with appropriate healthcare providers and community resourcesInitiate, manage, and track referrals through completionSupport residents in overcoming barriers such as transportation, housing instability, food insecurity, limited access to providers, and other social determinants of healthCoordinate care across healthcare providers, behavioral health organizations, public health agencies, schools, EMS teams, and community partnersFacilitate handoffs and communication between organizations to support continuity of careUtilize the Community Information Exchange (CIE) and other systems to document activities, monitor referrals, and track outcomesFollow up with residents to encourage engagement and service completionIdentify recurring barriers and service gaps and share insights to support Hub improvementsEscalate urgent medical, behavioral health, or safety concerns in accordance with established protocolsQualificationsMinimum QualificationsHigh school diploma or equivalent and relevant experience in community health work, care coordination, case management, patient navigation, Medicaid care management, behavioral health support, public health outreach, social services, or a related fieldExperience working directly with rural communities and/or high-need populations facing barriers such as transportation limitations, food insecurity, housing instability, low digital access, limited provider access, or fragmented behavioral health servicesExperience conducting resident, client, or patient intake and needs assessments and supporting referrals through completionAbility to manage multiple active cases while maintaining organized follow-up and coordination effortsExperience accurately documenting and tracking activities using digital systems such as a CIE, EHR, or case management platformValid driver's license and ability to travel throughout an assigned multi-county service areaStrong communication and relationship-building skills with residents, families, providers, and community organizationsPreferred QualificationsCommunity Health Worker (CHW) certification or related education, training, or certification in community health, public health, social services, behavioral health, human services, or a related fieldExperience utilizing a Community Information Exchange (CIE) or other closed-loop referral platformExperience working within an FQHC, RHC, Critical Access Hospital, behavioral health organization, local public health agency, EMS/community paramedicine program, school-based health setting, pharmacy program, home visiting program, or community-based organizationExperience supporting Medicaid members, dual-eligible residents, maternal-child populations, pediatric populations, individuals with chronic disease, behavioral health populations, or individuals experiencing substance use disorder or OUD-related support needsTraining or experience in motivational interviewing, trauma-informed care, health coaching, benefits navigation, Mental Health First Aid, suicide prevention, or other community-based behavioral health support approachesExperience connecting individuals to transportation services, nutrition programs, telehealth resources, preventive screenings, or home safety supportsRelevant frontline credentials such as Behavioral Health Support Worker, Emergency Medical Technician (EMT), Certified Nursing Assistant (CNA), or Pharmacy Technician training combined with strong community-based navigation experienceBilingual skills or demonstrated success serving culturally and geographically diverse rural communitiesWhat Makes You SuccessfulBuilds trust and meaningful relationships with residents to support ongoing engagement and care coordinationStays organized and effectively manages priorities across a community-based caseloadTakes a proactive, solutions-focused approach to removing barriers and connecting residents to servicesWorks collaboratively across healthcare, behavioral health, and community organizationsCommunicates clearly and professionally with diverse audiencesFollows established workflows while adapting to the unique needs of each resident and communityTakes ownership of referrals and follows through to completionDemonstrates persistence and strong follow-up skillsWorks independently and comfortably in field-based settings, including travel between homes, clinics, and community partner locationsPosition Perks & Benefits:Paid time off: full-time employees receive an attractive time off package to balance your work and personal lifeEmployee benefits package: full-time employees receive health, dental, vision, retirement, life, & moreTop-notch training: initial, ongoing, comprehensive, and supportiveCareer mobility: advancement opportunities/promoting from withinWelcoming, warm, supportive: a work culture & environment that promotes your well-being, values you as human being, and encourages your health and happinessBrightli is on a Mission:A mission to improve client care, reduce the financial burden of community mental health centers by sharing resources, a mission to have a larger voice in advocacy to increase access to mental health and substance user care in our communities, and a mission to evolve the behavioral health industry to better meet the needs of our clients.As a behavioral and community mental health provider, we prioritize fostering a culture of belonging and connection within our workforce. We encourage applications from individuals with varied backgrounds and experiences, as we believe that a rich tapestry of perspectives strengthens our mission. If you are passionate about empowering local communities and creating an environment where everyone feels valued and supported, we invite you to join our mission-driven organization dedicated to cultivating an authentic workplace.We are an Equal Employment Opportunity Employer.Preferred Family Health Care is a Smoke and Tobacco Free Workplace.