SDOH Health Population Navigator - QIP - FULL-TIME DAYS (25454)
$47,000-$60,000/Year
ApplySDOH Health Population Navigator - QIP - FULL-TIME DAYS (25454)
Posted 2 days ago
SENIORITY
Senior
SALARY
$47,000-$60,000/Year
About the role
- 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
- 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
- EducationBachelor's Degree in behavioral health field required. Master's Degree in behavioral health field preferred.
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