Patient Care Coordinator and Housing Navigator

Central City Community Health Center - Norco, CA3.8


Welcome to Central City Community Health Center where our mission is to provide quality patient centered health care to low-income, undeserved individuals. With 15 direct clinic locations in Los Angeles, North Orange County and the Inland Empire, as well as outpatient support to almost 700 private Residential Care facilities, our core value of exceeding patient relationships in a culturally sensitive manner translate into an environment where the welfare of our patients always comes first. We seek the best trained clinical and professional staff and strive to provide care in a culturally sensitive manner.

To support our mission we have an immediate need for Patient Care Coordinator and Housing Navigator


  • Responsible for assisting Members with care coordination needs, including, but not limited to, referral support, community resource connection, and health care navigation.
  • Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues within a Provider office setting.
  • Responsible for promoting a collaborative and effective working environment within the CB-CME by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as they arise, and collaborating on Member case discussions.
  • Responsible for assisting the Nurse Care Manager and/or the Behavioral Health Care Manager with appropriate treatment plan implementation and coordination of care needs, as developed in collaboration with the Member, and consulting with the clinical team members before taking any action that is clinical in nature.
  • Responsible for engaging with Members, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the Member and his or her medical/behavioral team, as well as to increase the Member's sense of control over their whole health.
  • Form and foster relationships with housing agencies and permanent housing providers, including supportive housing providers.
  • Partner with housing agencies and providers to offer the HHP member permanent, independent housing options, including supportive housing.
  • Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as identifying and addressing gaps, and by identifying, developing, and testing new practices for improving the outcomes of the HHP.
  • Assists with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services.
  • Oversee provision of HHP services, implementation of Complex Health Assessment
  • (CHA) and Health Action Plan (HAP)/Shared Care Plan (SCP)
  • Collaborates on Member care issues with other CB-CME team, participating in weekly systematic case reviews and ad hoc case reviews, and consults with Nurse Care Manager and/or the Behavioral Health Care Manager before taking any action that is clinical in nature.
  • Ensures documentations is accurate and in compliance with regulatory requirements and accreditation standards.
  • Performs any other duties as assigned or required to ensure HHP operations are successful.
  • Participates in HHP staff meetings or other activities as needed.
  • Monitor treatment adherence (including medication) and progress towards documented HAP goals and objectives.
  • Ensures the privacy and security of PHI (Protected Health Information) as outlined in


  • [HEALTH CARE ORGANIZATION] s policies and procedures relating to HIPAA compliance including attending annual compliance training.

Knowledge, Skills, Abilities and Attributes:

Education and Experience Requirements

· Possession of a high school diploma or equivalent.

· Medical Assistant Certification,

· Certified Nursing Assistant,

· Associate or bachelor’s from an accredited institution preferred

· A valid California driver's license, a reliable car, and valid automobile insurance are also required.

· Good Driving Record

· Two years customer service experience in any setting.

· Experience of successfully working within a team.

· Managed care setting experience preferred.

· Knowledge of Utilization Management including referral process, ICD-10 and CPT Codes preferred.

· Highly skilled interpersonally, with excellent team work and relationship skills.

· Knowledgeable about evidenced based communication such as Motivational Interviewing, or similar empathy-based communication strategies.

· Highly skilled in interpersonal communication, including resolving conflict.

· Able to sufficiently engage members and providers both on the phone and in person.

· Understanding of and sensitivity to multi-cultural community.

· Understanding of and sensitivity to mental health conditions and addictive disorders.

· Awareness of the impact of unmitigated bias and judgement on health; commitment to addressing both. Bilingual (English/Spanish) preferred.

· Strong organizational skills, typing 45 words per minute, proficient in Windows applications, telephone courtesy, high degree of patience, and experience in data entry.

· Understanding of, and a commitment to, high preforming team practices

Working Conditions

Normal clinic environment with:

  • Physical requirements for this position include: routinely walking and/or standing, hearing, seeing, speaking, feeling, reaching and repetitive motions.
  • Ability to handle multiple tasks while also being tactful, diplomatic, and empathetic.
  • Ability to organize, schedule work effectively, and work independently with minimal supervision.
  • Ability to communicate effectively and tactfully with patients, customers, managers and other levels of personnel, in person and on the telephone.

We offer a dynamic work environment with competitive salaries and benefits. Central City provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Central City complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities.

Job Type: Full-time


  • Clean Driving Record: 1 year (Preferred)
  • Windows: 1 year (Preferred)


  • High school or equivalent (Preferred)


  • CNA (Preferred)


  • English (Preferred)