Community Health Navigator

Reporting to the Program Manager, the Community Health Navigator provides hands on, practical support to vulnerable populations within the EOPCN who require assistance accessing medical, social, and community-based resources. This role is designed to complement and enhance the work of primary care professionals by addressing nonclinical barriers that impact a patient’s ability to function independently and engage in their care.

Community Health Navigators support patients with needs such as chronic disease management, social isolation, transportation, housing, financial supports, and navigation of healthcare and community services. While the role works collaboratively within an interdisciplinary Primary Care Network team and with community partners, it functions with a high degree of independence in day-to-day activities.

This position is Monday to Friday, in-person, at the EOPCN central office.

KEY RESPONSIBILITIES & DUTIES

• Conduct nonclinical assessments of patient medical, housing, financial, social, and emotional needs; identify barriers related to culture, language, literacy, and health literacy.
• Explore referral reasons (e.g., social isolation, transportation, government programs), support patients in articulating needs, and identify appropriate community resources.
• Develop and implement individualized, patient centered care plans with realistic SMART goals that reflect patient values and circumstances.
• Provide hands on, one on one support to connect patients with and use community resources (e.g., applications, scheduling, transportation, food and exercise programs), building self-advocacy and independence.
• Document assessments, care plans, and progress accurately in the EMR to support coordinated, multidisciplinary care.
• Collaborate with the Program Manager to review care plans and identify gaps or clinical considerations.
• Participate in multidisciplinary meetings (bi-weekly case consults, monthly team/staff meetings, quarterly multidisciplinary meetings) and educate team members on the Community Health Navigator role.
• Maintain current knowledge of community resources; contribute to workflow development, quality improvement, evaluations, and occasional special projects.

QUALIFICATIONS

• High school diploma required; preference for a one- or two-year diploma in healthcare, social services, or a related field.
• Additional training considered an asset (e.g., Mental Health First Aid, Trauma Informed Care).
• Minimum of two (2) years’ experience working with vulnerable populations in healthcare, social service, or community based settings; experience working independently to support access to resources or provide direct support preferred.
• Working knowledge of community resources for vulnerable populations is an asset.
• Proficiency with Microsoft Office, Outlook, and Teams; experience with electronic medical records is an asset.
• Equivalent combinations of education and experience may be considered.
• Access to a reliable vehicle required, as public transportation may be insufficient for patient visits.
• A Criminal Record/Police Information Check with Vulnerable Sector check