Care Navigator

• Provide specialized, harm-reduction-focused support to adults with HIV, adherence-related issues, or transferring care
• Meet with patients face to face, virtually, and by phone to provide education, counseling, support, and referrals
• Work as part of a multidisciplinary team with medical providers, community health workers, behavioral health staff, and other care team members
• Identify patients needing specialty adherence care and encourage appropriate referrals
• Systematically engage patients who are out of care and refer them to community agencies as needed
• Guide patients through Whitman-Walker and external services as a patient representative and advocate
• Make regular patient contact and develop individualized care plans supporting treatment adherence and long-term retention
• Identify and address barriers to retention and gaps in care
• Follow up with hospitalized patients, ER visitors, missed clinic visits, missed medication refills, or potentially non-adherent patients
• Coordinate with clinicians, case managers, behavioral health providers, and other healthcare providers
• Maintain accurate records in EMR and other data systems
• Prepare narrative, statistical, weekly, monthly, and annual reports
• Maintain a current resource list of community service organizations
• Participate in quality improvement activities, adherence training, and ongoing education
• Follow Whitman-Walker policies and procedures, including HIPAA requirements
• Perform other duties as assigned, including emergency-response tasks

• Participate as an active member of the transdisciplinary team
• Act as the primary point of contact for caregivers, families, support networks, and people living with chronic conditions
• Support caregivers, families, and people living with chronic conditions to enhance quality of life and ensure safety at home
• Conduct biopsychosocial assessments to identify strengths, goals, unmet health-related social needs, and safety concerns
• Develop personalized, culturally responsive care plans aligned with clients’ values and needs
• Provide disease- and stage-specific education using the resource library
• Refer and connect family caregivers and patients to community-based services and supports
• Communicate with primary care physicians and healthcare specialists to ensure continuity of care
• Provide caregiver education focused on burnout, self-care, resiliency, skills training, and support groups
• Track and maintain contact frequency based on the program model and policy
• Participate in monthly transdisciplinary meetings to collaborate and coordinate care
• Document all interactions, including presenting issues, goals, interventions, and action plans
• Follow company policies, procedures, clinical protocols, and client confidentiality requirements
• Represent Nolia Health at community events, health fairs, senior centers, and healthcare partner organizations
• Educate stakeholders about Nolia Health’s services and build relationships generating referrals and community engagement
• Provide virtual telehealth care to patients and families in home settings
• Provide ongoing case-management-type support in collaboration with MDs, Neuropsychologists, Nurse Practitioners, and Social Workers

Care Navigator jobs in Washington

Care Navigator

Care Navigator – Part-Time