Navigator

HAMILTON HEALTH CENTER INC•Harrisburg, PA

About The Position

The Navigator plays a critical role in coordinating care between patients and the health center by identifying barriers to care and connecting individuals to appropriate medical, behavioral health, and community-based services. This position supports improved health outcomes by assessing social determinants of health, facilitating timely referrals, and ensuring continuity of care through consistent follow-up. Working as an active member of the care team, the Navigator engages patients through in-reach, outreach, and home visits, providing education, advocacy, and guidance to help individuals successfully navigate the healthcare system and access available resources.

Requirements

High School diploma required with 2 or more years of comparable work experience; Associate degree preferred.
Minimum of three years of experience in a clinical environment working directly in inpatient care required.
Reliable transportation to travel throughout the service area.

Nice To Haves

Bilingual speaking preferred.
Knowledgeable in The Joint Commission regulations, preferred.
Working with children and families in Public Health, Outreach, Social Work, or related field, performing care coordination /care management in a medical setting, preferred, but not required if other relevant experience can be demonstrated.

Responsibilities

Participate as a Care Team member to help patients overcome barriers to care, such as lack of insurance or lack of transportation, mental health, and /or drug and alcohol problems.
Provide access to early intervention, screening, inclusive of depression, substance abuse, child development, and social determinants of health, and facilitate access to internal and external referral services.
Help develop, assess, and adjust as necessary in collaboration with the care team the patient-centered care plan, and promote desired outcomes along with monitoring the effectiveness of the plan along with establishing measurable goals and outcomes.
Screen for Social Determinants of Health using an approved tool and report specific health and social information back to the care team to assist in the development of the continuum of care/service plan.
Support the Care Team(s) by reaching out to patients who have missed critical appointments or who are overdue for preventive or obstetric care services.
Maintain constant communication with the patient while addressing their concerns, goals, and helping them keep positive attitudes and adherence to the treatment plan.
Utilize clinical judgment and critical thinking skills to help patients navigate appropriate physical and behavioral healthcare and coordinate psychosocial and medical wraparound services to promote effective utilization of available resources.
Identify social agencies and other resources as appropriate to the needs of the patient, including but not limited to medical, dental, mental, financial, and community resources.
Provide patient and family education to promote understanding of service rationale and coordination among community organizations/network providers and constituent groups.
Screen, identify, and close clinical and nonclinical gaps in patient care
Mitigate family dynamics and patient compliance issues.
Provide service coordination and facilitation of case management, and client advocacy.
Document service coordination activities throughout the continuum of care.
Monitor and follow up on client referrals and access to prevention/intervention and treatment needs.
Facilitate access to referral services to school districts.
Ensure accurate and appropriate use of medical terminology within documentation of patient interactions.
Maintain confidentiality and security rules when providing information to internal and external sources.
Travel throughout the service areas as required, providing home visits if needed by patients.