What You Will Do:JOB SUMMARY: This role coordinates care activities and promotes population health management by breaking down barriers and providing access to community and health resources to the patient in a primary care setting. Plays an integral part of the Care Transformation Organization (CTO) patient care team and works collaboratively within the department, primary care practices, specialty care providers, patients and their families to support healthcare navigation in the community. Identifies and addresses gaps in care to create a reduction in emergency room visits and inpatient stays. Manages referrals to the CTO team and other community agencies as needed. MINIMUM KNOWLEDGE, SKILLS AND ABILITIES: Education & Training: High school diploma or equivalent is required. Associate's degree preferred. Work Orientation & Experience: Two (2) years of experience in a medical office setting or healthcare environment required. Previous electronic medical record experience preferred. Knowledge of medical and insurance terminology and navigating the healthcare system required. Skills & Abilities: Demonstrate skill in a) customer service; b) oral and written communication to address inter- and intradepartmental concerns, solve problems and address conflict; c) working knowledge of sanitation, personal hygiene and basic health and safety precautions applicable for work in a clinical setting; d) effective use of EMR, e-mail, the internet, word processing, spreadsheets, presentation and database packages, etc. e) navigating the health care system and providing resources to patients. Demonstrate ability to a) problem solve and use available resources in innovative ways; b) understand and follow oral and written instructions generally acquired through a high school education and medical assistant programming; c) document and communicate pertinent information; d) establish and maintain effective working relationships with patients and the care team; e) demonstrate an understanding and sensitivity to serving culturally diverse population while respecting patient confidentiality; and f) must have reliable transportation.What You Need to Be Successful:We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.