Umpqua Health

The Care Navigator serves as a guide and advocate for members, helping them navigate healthcare and social service systems to improve health outcomes and overall quality of life. Through member engagement, education, coordination, and barrier reduction, this role supports members in accessing services, understanding available care options, and connecting to community resources that address medical, behavioral health, and social needs. The Care Navigator also facilitates communication among providers, care teams, and service partners to support continuity of care and reduce barriers impacting member wellbeing. 

This is a non-clinical role focused on member engagement, access, and navigation support. The Care Navigator operates within standardized tools, protocols, and established workflows and does not perform clinical assessments, diagnoses, or care plan development. All clinical concerns, higher-acuity needs, and issues requiring clinical judgment are escalated to Care Coordinators or licensed clinical staff in accordance with established procedures. 

• Engage members identified through data analysis, referrals, provider recommendations, or community sources, with a focus on low-risk or rising-risk members appropriate for navigation-level support. 

• Conduct standardized screenings using approved assessment tools and escalate findings requiring clinical interpretation to licensed care team members. 

• Provide culturally responsive health education, supportive guidance, and resource navigation to promote healthy behaviors and self-management. 

• Support members with healthcare access needs, including appointment scheduling, benefit understanding, and connection to appropriate services. 

• Monitor and identify changes in member condition, risk status, barriers to care, or unmet needs and escalate concerns to Care Coordinators or licensed clinical staff according to established workflows. 

• Conduct community outreach activities, including home visits, transportation coordination, and connection to medical, behavioral health, substance use, and social service resources. 

• Provide telephonic and face-to-face follow-up with members and care team partners to support care plan activities, appointment adherence, and medication coordination. 

• Collaborate with care managers and interdisciplinary teams to coordinate referrals to community-based organizations and network providers addressing identified member needs. 

• Communicate timely updates regarding member progress, risks, barriers, and unmet needs to care managers, providers, and care team partners. 

• Maintain accurate, timely, and audit-ready documentation in compliance with organizational policies, contractual requirements, and regulatory standards. 

• Travel throughout the service area as needed to support field-based member engagement activities, including home and community visits, with fieldwork constituting at least twenty-five percent of assigned duties. 

• Perform other duties as assigned; responsibilities may be modified based on organizational needs. 

Performance Expectations 

• Member outreach and engagement targets 

• Appointment scheduling completion rates 

• Resource linkage completion rates 

• Timeliness and accuracy of documentation 

• Effective escalation of higher-risk or clinical needs 
   

• Working with a variety of personalities, maintaining a consistent and fair communication style.
• Satisfying the needs of a fast-paced and challenging company.

• Medical Assistant, Certified Clinical Medical Assistant, or OHA-recognized Traditional Health Worker (THW) certification, such as Community Health Worker (CHW), Peer Support Specialist, or Personal Health Navigator (PHN). 
  Three (3) years of experience in a healthcare or community health setting. 
  Must possess a valid driver’s license and maintain current automobile insurance in accordance with minimum state requirements. 

• Ability to recognize potential barriers, unmet needs, or changes in member status and appropriately escalate concerns to clinical staff. 
  No suspension, exclusion, or debarment from participation in federal healthcare programs (e.g., Medicare or Medicaid). 

• Proficiency in computerized systems for data entry, documentation, and information retrieval. 

• Ability to identify member barriers and support resolution through appropriate referral and escalation processes. 

• Working knowledge of community resources, providers, and healthcare facilities that support member needs. 

• Demonstrated commitment to confidentiality, privacy, and protection of health information in accordance with organizational and regulatory requirements. 

• Associate degree in healthcare, social services, public health, or a related field preferred. 

• Experience collaborating with providers and interdisciplinary healthcare teams. 

• Understanding of healthcare benefits, covered services, and community-based support options. 

• Knowledge of care navigation practices and community-based member support services. 

• Ability to identify barriers to successful care coordination and assist in developing appropriate solutions. 

• Bilingual or multilingual communication skills preferred. 

• Salary is dependent on skills, experience, and education
• Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave
• Medical, dental, and vision insurance
• 401(k) with company match (fully vested immediately)
• Company-sponsored life insurance and additional benefits
• Fitness reimbursement program
• Tuition reimbursement and more