Community Based Coordination Solutions seeks dynamic fulltime Community Health Navigator (CHN) to join our New Mexico team. The CHN identifies barriers and helps coordinate care for an at-risk, complex patient population.

Position Available: Community Health Navigator
Location: Espanola, NM

Reports To: Program Manager

Job Status: Exempt, Full‐time

Benefits: Health benefits; Travel stipend; 401K program

Salary: $27/hour to start

Position Summary
The CHN coordinates community and other resources to improve health care delivery for a complex patient population. The position includes significant field time with a variety of direct patient engagement duties including:

conducting initial intake assessments and risk reduction interventions
assistance/coordination with access to community resources
assistance coordinating transportation and housing as needed
engagement during crisis periods
resource engagement and allocation
regular meetings with clients’ care-teams

The CHN works as part of a team under the direction of a Program Manager. The position involves direct interaction with individuals deemed to be high utilizers of community resources to improve their overall care and help mitigate crisis events. The community health navigator will be interacting with patients, primary care providers, medical specialists, social service entities and other community resources to provide an improved care plan for enrolled individuals. Enrolled individuals have typically been identified as “complex,” and most struggle with issues of homelessness, substance abuse and/or mental health.

Qualifications
This job requires the ability to demonstrate patience and understanding with this high medical and behavioral needs cohort, and the ability to navigate and assist clients with a number of challenging medical and social issues. While most duties will be conducted during pre-determined office hours, there will be requests for off-hours work.

We emphasize the following traits for this position:

Desire and comfort working directly with at-risk individuals
Lived experience with issues of homelessness, substance abuse, and/or mental health
This position does require local travel, and a valid driver’s license is required; access to your own reliable transportation is preferred.
Basic computer access, intake and filing skills. Ability to access electronic information and participate in virtual meetings via tools such as Zoom.
Current or ability to obtain Community Health Worker Certification preferred

Skills

Preferred skills for the position include, but are not limited to, the following:

Patient engagement
Performing intake assessments
Maintaining frequent patient contact including reminders of appointments; assistance/encouragement to appointments
Engaging individuals after each emergency department and/or primary care visit
Assisting clients in finding resources (housing; transportation; food; care)
Note – Many of the duties will be customized depending on the needs of each individual patient
Ability to work directly with clients that may be suffering from any number of psycho-social issues including, but not limited to, mental health disorders, substance abuse issues, chronic medical conditions, and homelessness.
Carry out work duties in a confidential and respectful manner, even when under stress.
Care Plan creation and maintenance
Engagement of local/regional Electronic Medical Records in a HIPAA compliant fashion
Attending local community meetings as needed
Knowledge of local community challenges preferred
Engagement of community resources involved in patient’s care; this may include (but is not limited) to resources such as:
Emergency Department personnel
Primary Care Providers and Specialists
Law Enforcement agents
EMS personnel
Behavioral Health Centers
Substance Abuse Treatment Centers
Therapeutic Courts
Jails
On-Call providers
Housing Authorities
Other community care coordinators and/or agencies

Positional Roles and Responsibilities

Member enrollment into program – this will typically involve phone and direct home and/or field-based contact with members during the enrollment process.
Create care plans for every enrolled member.
Assist members in a variety of activities in-home and community-based services, which may include assistance scheduling appointments, assist with travel to/from medical appointments, and engaging providers and community resources as needed.
Problem-solve with members their barriers to care and establish with members their goals of care.
Be available after hours (through a rotational call schedule) for emergent member needs.
Work with team to create monthly client enrollment lists.
Work with a variety of local resources, including (but not limited to) law enforcement, EMS, housing, medical, treatment, jail, shelters, and a variety of governmental agencies in development of ideal member enrollment plans. Participation in community multi-disciplinary teams as needed.
Timely and accurate documentation of practices as per organizational policies and procedures

Organizational Roles and Relationships

Adhere to organizational values and policies.
Actively participate in organizational performance improvement activities
Report directly to Program Manager
Work in a team-based model of care
Perform other duties on an as-needed basis
Report to organizational leaders upon request
Assist in submitting reporting data to organization as needed
Protect client personal health information by compliance with HIPAA and additional relevant health-care IT related regulations.

CBC Solutions is an equal opportunity employer and will not tolerate discrimination based on race, color, religion, sex (including pregnancy, sex stereotyping, gender identity, gender expression or transgender status), national origin, sexual orientation, physical or mental disability, age, protected genetic information, status as a parent, marital status, political affiliation, or retaliation based on prior protected EEO activity.

Job Types: Full-time, Contract

Pay: From $27.00 per hour

Benefits:

401(k)
Dental insurance
Employee assistance program
Health insurance
Paid time off
Vision insurance

People with a criminal record are encouraged to apply

Work Location: On the road

CBC Solutions

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