Community Health Navigator, Patient Engagement

Imagine Pediatrics•South Padre Island, TX

4d•$23 - $28•Remote

About The Position

Imagine Pediatrics is a tech-enabled, pediatrician-led medical group that is reimagining care for children with special healthcare needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care, collaborating with families, providers, and health plans to overcome barriers to quality care. Their approach enhances existing care teams by providing an additional layer of support with compassion and creativity, focusing on children with medical complexity. This role is primarily remote in South Texas, with frequent travel required throughout the region. As part of the Patient Engagement Team, the Community Health Navigator supports patients in re-engaging with Imagine Pediatrics services. The role partners with an interdisciplinary team to address patient needs and enhance the re-engagement of patients who were previously enrolled but did not complete onboarding or have not actively utilized services. The goal is to ensure these patients are supported in reconnecting with Imagine Pediatrics care.

Requirements

A valid driver’s license
A bachelor’s degree
Bilingual (Spanish)
Ability to travel frequently
National CHW certification
3+ years of experience in a healthcare setting (patient-facing hospital or facility role)
Ability to navigate ambiguity, think critically, take initiative, and stay organized
Ability to manage multiple tech platforms
Experience working in a patient-facing hospital or facility role
Experience working as part of an interdisciplinary team

Responsibilities

Serve as a community-based, patient-facing resource, building relationships with patients and caregivers through direct, in-person re-engagement in assigned geographic areas.
Provide hands-on support to patients and caregivers, including assisting with program re-enrollment, onboarding, and mobile app setup and utilization.
Perform telephonic outreach to caregivers of attributed patients to re-engage children in care, support seamless onboarding, and re-engage those who missed their initial onboarding visit or have not utilized services post-onboarding.
Educate patients and caregivers on Imagine Pediatrics services and available community resources, ensuring they understand how to access care and support.
Maintain and gather up-to-date knowledge of local community resources (e.g., social services, healthcare providers, SDOH supports) and connect families to appropriate services.
Conduct community events and facility rounding to engage eligible patients, strengthen relationships, and support ongoing program participation.
Partner with Behavioral Health teams and local behavioral health providers to support safe patient discharge planning and ensure seamless connection to community-based resources and ongoing care.
Partner with caregivers, families, and facility staff to identify and address barriers to engagement and access to care, and work with leadership on ensuring workflows exist to enable access to care.
Collaborate closely with the Patient Engagement Team (Outreach & Enrollment), including Outreach Specialists and Registered Nurses, to support patient re-engagement goals.
Support non-clinical care coordination efforts in the community, including assisting with connecting patients to primary care providers, facilitating pharmacy access and medication-related needs, providing basic discharge and follow-up support, addressing social determinants of health (SDOH) needs, and removing barriers to care and service access.
Support outreach efforts through outbound engagement calls, as needed, to assist with enrollment, follow-up, and achievement of patient engagement metrics.