Care Navigator Jobs

About The Position

Requirements

• High school diploma or GED required.
• Minimum of two (2) years of experience in healthcare, care coordination, community health work, patient navigation, or related field required.
• Experience working with vulnerable populations or within primary care, hospital discharge planning, or care coordination strongly preferred.
• Possesses basic knowledge and skill appropriate to education/training.
• Telephone and computer skills.
• Flexible in accepting work assignments.
• Possesses the ability to seek and utilize supervision appropriately.
• Ability to communicate effectively with a diverse patient population.
• Professional interpersonal communication skills.
• Ability to function as a committed and reliable team member.
• Must be able to sit, stand, and or walk for an entire workday.
• Must be able to lift, carry, push, pull, and or twist while holding up to 25 lbs. frequently.

Nice To Haves

• Associates degree in healthcare, social services, or related field preferred.
• Community Health Worker (CHW) certification preferred.
• Bilingual (English/Spanish) preferred.

Responsibilities

• Establishes direct contact with patients during hospitalization to assess needs, introduce transition support services, reinforce the importance of follow-up care, and begin discharge planning in collaboration with hospital staff.
• Serves as a liaison between the hospital team and GLBHC primary care site to coordinate timely follow-up appointments and support continuity of care after discharge.
• Facilitates scheduling of hospital follow-up appointments with the patient’s GLBHC primary care site within recommended timeframes.
• Conducts post-discharge outreach to confirm appointments, reinforce discharge instructions, and support patient adherence to follow-up care plans in coordination with primary care nursing staff.
• Assesses patient barriers to care including transportation, financial concerns, health literacy, insurance coverage, and other social determinants of health.
• Works collaboratively with internal staff and community resources to address barriers and facilitate successful attendance at follow-up visits.
• Works closely with providers, nurses, care managers, community health workers, and other care team members to support continuity of care following hospital discharge.
• Participates in care team meetings, huddles, and case discussions to ensure coordinated care plans for high-risk patients.
• Provides guidance and education to patients and families regarding the importance of follow-up care, medication adherence, and available community resources.
• Supports patients in navigating the healthcare system and accessing services that promote recovery and ongoing health management.
• Maintains accurate and timely documentation of all patient interactions and coordination activities within the electronic medical record and applicable tracking systems.
• Monitors and reports transition-of-care performance indicators and assists in quality improvement initiatives related to hospital follow-up care.
• Participates in team meetings.