Community Health Navigators (CHN) are non-clinically licensed health care staff members who are frontline public health workers deployed in clinical and community care settings to improve the social health of Neighborhood Health Center (NHC) patients in the communities we serve. Navigators act as the quarterback of the care plan for members who have unmet social, medical, and behavioral needs. They work with patients, families/ caregivers, medical providers, and community partners to coordinate care and services across the continuum.

Essential job duties:

• Assist patients with social issues like houselessness, substance abuse and mental health resources, and food insecurity resources, and assess need through social determinants of health (SDOH) screenings.
• Assist patients with organizing their medical care by making follow-up appointments, filling prescriptions, and connection to specialty health as needed.
• Support patients through providing resources to connect to benefits and public assistance program; examples are health insurance, food stamps, and other resources as needed.
• Initiate a follow-up call to patients who have been discharged from the emergency department or hospital following behavioral health crises within 24-48 hours post discharge. Assess and offer mental health resources, SDOH screening, care coordination, and scheduling with behavioral health and clinical pharmacy post hospital or ED visits.
• Build rapport with patients to engage them in their care plan, offering encouragement and guidance in addressing their behavioral health needs.
• Collaborate with the primary care team, Behavioral Health Consultants (BHCs), and external providers to ensure smooth transitions of care and continuity of services for patients’ post-discharge.

Education and experience:

• Minimum two (2) years of experience in a community/clinic-facing role, addressing social determinants of health in a healthcare setting, navigation across health systems, and post hospital/emergency room visit outreach is required.
• High School Diploma or General Education Development (GED) is required.
• Completion of the approved state certified THW/CHW is required.
• Bilingual in Spanish preferred. 

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