Healthcare Navigator

Status

Full‑Time, Salary, Exempt

Veteran Services

Senior Director of Veteran Services

The SSVF Healthcare Navigator assists Veterans who are homeless or at risk of homelessness to end their housing crisis. The goal is to provide services that assist veterans in ending their housing crisis, expand independent living skills through supportive services and education, connect them with community resources, and empower them to maintain long‑term housing stability and self‑sufficiency. The role includes connecting Veterans to VA health care benefits or community health care services, providing health education, interdisciplinary collaboration, overall case management and care coordination, and working closely with the Veteran’s primary care provider and assigned interdisciplinary treatment team.

• Master of Social Work or a master’s degree in a related field with less than five (5) years of work experience; or
• Bachelor of Social Work or related undergraduate degree with more than five (5) years of related work experience; or
• Nine (9) years of experience in the field with no degree; or
• Veteran with six (6) years of experience in the field.

• Work closely with the Veteran’s assigned multidisciplinary team, including medical, nursing, and administrative specialists, and the case management team.
• Provide timely, appropriate, and equitable Veteran‑centered care as the primary case manager for all Veterans placed in hotels by the SSVF program, collaborating with the treatment team to identify and address systemic challenges.
• Serve as liaison between all SSVF Healthcare Navigators and Veteran Services leadership, and serve as the main trainer for new and existing staff.
• Maintain personal automobile, valid driver’s license, and liability insurance; be willing and able to travel between the counties served up to 70% of the time.
• Complete required case management training within 90 days of hire and complete all VA‑required training for SSVF personnel and Healthcare Navigators.
• Conduct assessments of Veterans in collaboration with the interdisciplinary treatment team, Veterans, family members, and significant others.
• Use assessments to understand the Veteran’s situation, barriers to care, causes, and impacts on ability to access and maintain health care services.
• Highlight the Veteran’s strengths, limitations, risk factors, internal/external supports, and service needs to optimize access to health care services.
• Arrange and set up appointments with Veterans and treatment teams through virtual means or telehealth.
• Act as a health coach by proactively supporting Veterans to optimize treatment interventions and outcomes.
• Perform assessments, develop and monitor case plans, and conduct necessary follow‑up activities.
• Establish linkages with appropriate agencies and service providers in the community.
• Provide referrals and resources.
• Educate participants on issues such as supportive services available and participants’ rights.
• Provide supportive services to participants.
• Complete required documentation, including progress notes, within 48 hours of contact and enter data into the Homeless Management Information System (HMIS).
• Demonstrate good clinical judgment in decision making regarding participants.
• Demonstrate ability to relate to Veterans and their families in a culturally competent manner.
• Perform performance quality improvement duties as assigned by supervision and the PQI Committee.
• Work in partnership with other SSVF Case Managers, Intake Coordinators, and Outreach Workers.
• Serve as a resource for education and support for Veterans and their families, helping identify appropriate and credible resources tailored to their needs.
• Participate in the development of the Veteran’s care plan with an emphasis on community services, outreach, and referrals.
• Evaluate effectiveness of resources and referrals provided and modify to ensure high‑quality care.
• Monitor Veteran’s progress, maintain comprehensive documentation, and provide information to treatment team members when appropriate.
• Identify concerns or questions about the Veteran’s treatment or medications and develop open communication…