Community Navigator - St. Rita's Medical Center

Thank you for considering a career at Mercy Health!

Scheduled Weekly Hours:

Work Shift:

Position Summary

The Community Navigator supports Mercy Health Lima clinics by providing comprehensive, community-based navigation and coordination services that address the social determinants of health (SDOH), improve care coordination, and enhance access to health system and community resources for underserved and vulnerable populations. This role works collaboratively across multiple care settings, including mobile and community clinics, primary care practices, and community partner sites.

The Community Navigator collaborates with physicians, clinic staff, community organizations, and other stakeholders to deliver holistic, patient-centered care. This position requires a self-directed professional who can work across clinical and community environments, manage competing priorities, support care transitions, and contribute to program development, data tracking, and continuous improvement efforts aligned with organizational mission and grant deliverables.

Essential Job Functions

Direct Patient Services & Care Navigation (40%)

• Conduct standardized social determinants of health (SDOH) screenings with patients served through the mobile clinic and community-based clinics
• Provide individualized care navigation, including assessment of social, financial, behavioral health, housing, food, transportation, insurance, and utility needs
• Assist patients with applications, referrals, appointment scheduling, and follow-up for community and health system services
• Support uninsured or underinsured patients with insurance enrollment assistance and linkage to primary care
• Provide brief education and counseling related to identified social needs and available resources

Care Coordination & Clinical Integration (20%)

• Collaborate with resident physicians, attending providers, and clinic staff to support continuity of care and reduce fragmentation
• Facilitate referrals to primary care, specialty care, behavioral health, and community services
• Support transitions of care between mobile clinic visits, resident clinic care, and community partners
• Participate in interdisciplinary team meetings and contribute to patient-centered care planning

Community Partnerships & Outreach (15%)

• Build and maintain relationships with community-based organizations addressing food insecurity, housing, transportation, employment, and behavioral health
• Represent Mercy Health at community events, mobile clinic sites, and partner locations as appropriate
• Coordinate with partners such as food banks, community centers, faith-based organizations, and free clinics to strengthen referral pathways
• Serve as a trusted liaison between patients, clinics, and community resources

Data Collection, Documentation & Grant Reporting (15%)

• Document patient encounters, SDOH screenings, referrals, and follow-up activities in approved tracking systems and/or the electronic health record
• Track referral outcomes and successful connections to services in alignment with grant objectives
• Assist with data collection and reporting related to grant deliverables, outcomes, and performance measures
• Participate in quality improvement efforts to enhance screening rates, referral success, and patient engagement

Program Development & Education (10%)

• Support the development and refinement of SDOH workflows within mobile and clinic-based care settings
• Provide patient education related to community resources, insurance, chronic disease management, and health access
• Assist with training resident physicians and clinic staff on SDOH awareness, referral processes, and community resources
• Contribute to program sustainability planning through documentation of outcomes and lessons learned

Employment Qualification

Education: A Baccalaureate degree in social work, psychology, sociology, or other field related to social work services.

Required:

• A bachelor’s degree in social work, psychology, sociology, public health, human services, or a closely related field.
• Strong communication, documentation, and organizational skills
• Ability to work independently, manage competing priorities, and function effectively across clinic, mobile, and community-based settings

Preferred:

• Experience in healthcare, mobile health, community clinics, or residency-based clinical settings.
• Social work certification or credential (e.g., Licensed Social Worker [LSW] or equivalent), or progress toward licensure.
• Certification, licensure, or formal training in social work, care coordination, or community health navigation.
• Comfort working in non-traditional clinical settings (mobile clinics, community sites)

Work Environment

• Combination of clinic-based, mobile clinic, and community-based work settings
• Travel required within a four-county service area
• Some evening or weekend hours may be required to support community events or outreach

Mercy Health is an equal opportunity employer.

As a Mercy Health associate, you’re part of a Misson that matters. We support your well-being – personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way. 

What we offer
•    Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
•    Medical, dental, vision, prescription coverage, HAS/FSA options, life insurance, mental health resources and discounts
•    Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
•    Tuition assistance, professional development and continuing education support

Benefits may vary based on the market and employment status.
 

Department:

It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). Accordingly, all applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health– Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employer, please email [email protected]. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at [email protected].