Care Navigator

Function:

Organizational duties & responsibilities:

1. The primary responsibility of all staff is to ensure the safety and well-being of all Ramey-Estep/Re-group (RE) clients.
2. Supports the mission, vision, and values of RE.  Facilitates and adheres to the agency’s code of ethics, policies, and procedures.
3. Supports all functions that attain and maintain accreditation and compliance with regulatory agencies.
4. Supports and facilitates positive interaction with clients and staff by exhibiting both in-office and in-public when carrying out job duties:  individual maturity, respect for others, a team-centered approach, maintenance of confidential information, and awareness and sensitivity to cultural and other differences in clients and staff.
5. Exhibits effective communication skills, including proper use of agency communication systems.
6. Participates in appropriate professional development programs to attain and maintain competency.
7. Effectively manages financial and physical resources to achieve the mission of RE.
8. Reports incidents of abuse or potential abuse involving clients to the appropriate authorities and RE.

Essential Duties and Responsibilities:

1. Welcome and support clients in-person, via phone, or telehealth.
2. Conduct initial screenings to determine eligibility and service needs.
3. Complete intake forms, consent, and release documents (HIPAA/42 CFR Part 2 compliant).
4. Educate clients on available services, rights, grievance procedures, and community resources.
5. Connect clients to behavioral health, primary care, and community support services.
6. Track and follow up on referrals to ensure successful connection.
7. Help clients overcome barriers such as transportation, housing, employment, insurance, or documentation.
8. Collaborate with clinical and case management teams on individualized care plans.
9. Maintain consistent contact with clients through calls, virtual check-ins, and in-person visits.
10. Support clients in setting and achieving personal goals.
11. Monitor client progress, identify unmet needs, and escalate risks to the care team.
12. Participate in treatment team meetings, case reviews, and care planning discussions.
13. Participate in community outreach events and rotating crisis/on-call support as directed by supervisor(s).
14. Respond to urgent client needs in coordination with crisis and clinical teams.
15. Assist in safety planning, Psychiatric Advance Directives (PADs), and connection to stabilization resources.
16. Support transitions and discharges, ensuring continuity of care and follow-up.
17. Document client interactions, progress notes, referrals, and care plan updates in the EHR.
18. Track outcomes using agency-approved tools (PHQ-9, GAD-7, CANS, etc.).
19. Assist with data collection for Continuous Quality Improvement (CQI) and program reporting.
20. Provide in-person support for high-need clients, intakes, and community events.
21. Conduct telehealth check-ins and administrative follow-up remotely.
22. Adapt flexibly between fieldwork and virtual tasks to meet client and program needs.
23. Performs other duties as assigned.

Working conditions/environment:

1. Schedule is typically Monday – Friday, day shift.
2. Holidays, weekends, and extra hours may occasionally be required.
3. A fast-paced environment with the need for quick decisions to deal with any crisis that may arise.
4. This position is based on an office, community, and remote responsibilities model with extensive computer usage.
5. Occasional regional travel to meet clients and attend partner meetings.
6. Maintains a positive, professional attitude, contributing to a supportive work environment.

minimum job requirements:

Education:

Experience:

Specific Skills and

requirements:

Specialized Licenses or training:

Physical Requirements:

Supervisory Requirements: