SDOH Health Population Navigator - QIP - FULL-TIME DAYS (25454)

Bergen New Bridge Medical Center; Paramus (NJ); On-site; USD 47,000 - 60,000; Full time

Benefits offered by this job

Competitive medical, dental, and vision plans

Generous time off policy

Tuition reimbursement and continuing education programs

Job summary

Bergen New Bridge Medical Center is hiring a SDOH Health Population Navigator in Paramus, NJ. This role involves coordinating patient care, tracking appointments, and connecting with community resources. Ideal candidates will have experience working with vulnerable populations and strong knowledge of social determinants of health.

The position requires strong communication skills, a Bachelor's degree, and the ability to work independently and within a team. Benefits include comprehensive medical plans and generous time off.

Qualifications

• Experience as a Community Health Worker or care coordinator.
• Strong knowledge of social determinants of health.
• Experience with community-based referrals and resource navigation.

Responsibilities

• Contact patients post-discharge for follow-up.
• Communicate with patient care team for integrative care.
• Coordinate treatment plan adherence and follow-ups.

Skills

Community Health Worker experience

Knowledge of SDOH

Referral and resource navigation

Communication skills

Healthcare experience

Problem-solving skills

Education

Bachelor's Degree in behavioral health

Master's Degree in behavioral health (preferred)

Job description

Join Our Team at Bergen New Bridge Medical Center!

We are dedicated to providing high-quality, compassionate care to our diverse community. As a leading healthcare provider, we offer a supportive and inclusive work environment. If you’re passionate about making a difference and thrive in a collaborative setting, Bergen New Bridge Medical Center is looking for a The SDOH Health Population Navigator.

Job Duties

Contacts patients post discharge per QIP-NJ contractual requirements.

Communicates with patient Care Team members (physicians, behavioral health team and/or other health care providers) to provide patient with integrative care.

Carries out tasks to execute the medical and support service plans including but not limited to guiding patients to appointments and accompanying them when necessary.

Acts as the primary liaison with medical providers to ensure patient adherence to care.

Tracks patient attendance for medical appointments, initiates outreach as well as adhering to missed appointment procedures.

Coordinates treatment plan adherence.

Coordinates deliverables per HORIZON ISC program.

Monitors internal data dashboard to coordinate patient care.

Identifies community resources to address patients' social determinants of health.

Provides referrals to community resources as needed and follow up to ensure referral completion.

Maintains program database of community partners and referrals.
Maintains documentation of all patient encounters and completes reporting requirements according to organizational and contractual requirements.

Maintains strict confidentiality in accordance with state and agency policies.

Attends and represents the organization at professional conferences, in-service training, and meetings at the request of or with the approval of supervisor.

Flexibility with covering weekend/evening shifts.

Performs other duties as assigned to support the overall objectives of the department and organization.

Core Competencies & Experience Needed

• Experience working as a Community Health Worker, care coordinator, or patient navigator serving complex or vulnerable populations
• Strong knowledge of SDOH, including housing instability, food insecurity, transportation barriers, benefits access, and other non-clinical drivers of health
• Demonstrated experience with community-based referrals and resource navigation, including follow-up to ensure successful connections (closed-loop referrals)
• Ability to work with high-utilizers and patients with complex medical, behavioral health, and social needs
• Familiarity with community-based organizations, county social services, and benefit systems
• Strong communication, engagement, and documentation skills, particularly in interdisciplinary care settings
• Experience working in healthcare, social services, or community-based settings, preferably within a safety-net or Medicaid-focused environment

Position Qualifications

• Excellent communication and interpersonal skills
• Experience working with behavioral health and/or substance use population.
• Experience working in a medical or social services environment preferred
• Strong attention to detail
• Proficient with computer databases
• Analytical problem-solving skills
• Ability to manage time, prioritize, and meet deadlines
• Ability to work independently and as a team member
• Good attitude, professionalism, promote team attitude
• Proficiency in Spanish preferred

Education

Bachelor's Degree in behavioral health field required
Master's Degree in behavioral health field preferred

Salary

Salary commensurate with experience within posted range

$47,000-$60,000/Year

Benefits

We provide a comprehensive benefits package, including a competitive medical, dental, and vision plans. We prioritize work-life balance with a generous time off policy that includes ample vacation days, personal time, sick leave and nine paid holidays. Additionally, we are committed to the personal and professional growth of our employees, offering robust tuition reimbursement and continuing education programs to help support our employees ongoing development.

Please note that selection of the candidate for any position will depend on several factors, including the individual’s educational background, skills, and professional experience.