Integration Specialist – BA

Sea Mar Community Health Centers

Integration Specialist coordinating Health Home services for underserved Washington communities. Conducting screenings, creating care plans, coordinating providers, and supporting chronic-condition self-management.

Posted 8/17/2026full-timeElma • Washington • 🇺🇸 United StatesJuniorMid-Level💰 $27 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Health Home services, care coordination, and community resource navigation while effectively managing a diverse caseload of patients with complex medical and behavioral health needs. Proficient in developing Health Action Plans and conducting various health screenings to support chronic-condition self-management.

Highest-signal resume keywords

BSW Or BA/BS In Human ServicesExperience In Social-Service Case ManagementHealth Homes Care Coordinator CertificationCPR/BLS CertificationKnowledge Of Community Resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Health Action Plan DevelopmentFunctional ScreeningMedical Self-Management ScreeningSubstance-Use ScreeningChronic Condition ManagementTyping Proficiency Of At Least 45 Words Per MinuteBasic Arithmetic SkillsElectronic Health-Record ApplicationsMicrosoft Office ProficiencyOutcome Measurement Monitoring

Soft Skills

Organizational SkillsCommunication SkillsCultural AwarenessProfessionalismAbility To Work Independently

Certifications & Qualifications

CPR/BLS CertificationHealth Homes Care Coordinator Certification

Industry Keywords

Health Home ServicesCare CoordinationChronic ConditionsBehavioral HealthCommunity AgenciesUnderserved PopulationsTransitional CareCase ManagementPatient SupportDiverse Populations

About the role

Key responsibilities & impact

Provide Health Home services and supports to patients with complex medical, behavioral health, and social concerns
Meet patients in homes, communities, inpatient settings, or clinics
Conduct functional, medical self-management, fall-risk, depression, anxiety, substance-use, and other screenings
Make referrals to internal Sea Mar providers, community resources, and emergency services
Develop Health Action Plans with long- and short-term goals and actionable steps
Provide health promotion, patient/family support, care coordination, transitional care, community and social-resource referrals, and comprehensive care management
Monitor patients for symptom, circumstance, and medication changes and communicate relevant information to providers
Review Health Action Plans and screenings with patients or families every four months
Support chronic-condition self-management and provider visits
Participate in case reviews and multidisciplinary care-team meetings
Collaborate with Care Management RNs, Integration Specialists, and Care Managers
Coordinate with behavioral-health providers, community providers, and case managers
Document calls, visits, contacts, and encounters; gather and monitor outcome measurements
Maintain appointment reconciliation in the scheduling database
Manage an assigned caseload of up to 60 patients and provide up to two contacts per month for high-intensity patients
Perform other duties as assigned

Requirements

What you’ll need

BSW or BA/BS in Human Services, Health Sciences, or a related field, with experience in social-service case management or care coordination
Other bachelor’s-level applicants with similar experience may be considered subject to contractor/state certification approval
Applicants without the degree may be considered with two years of relatable experience and contractor/state certification approval
Experience working with underserved, transient populations
Experience with substance-use disorders, chronic mental illness, and chronic medical conditions
Experience working with community agencies and strong knowledge of community resources
Ability to work effectively with diverse persons and groups with cultural awareness
Good organizational and communication skills, professionalism, and appropriate boundaries
No history or evidence of alcohol or drug misuse for three years before employment and no misuse while employed
No felony conviction within the last seven years and no conviction for assault, abuse, fraud, or specified harmful crimes
Valid driver’s license, auto insurance, and a vehicle safe for daily use
Driver’s abstract must demonstrate safe driving before hire
Ability to work in clients’ homes, community settings, and clinics
Understanding of medical terminology related to chronic conditions
Ability to work independently and as an interdisciplinary team member
Ability and willingness to work with translators if not bilingual
Must obtain CPR/BLS certification within the initial probationary period or within 90 days of hire and maintain it throughout employment
Must complete agency and state mandatory training
Must acquire and maintain state Health Homes Care Coordinator certification when contractually required
Up-to-date vaccination record
Pre-hire and annual TB screening
Annual employee health screening
Annual influenza vaccination, unless an approved medical or religious exemption applies; exempt employees must wear a mask during flu season
Typing proficiency of at least 45 words per minute
Demonstrable computer skills and ability to learn electronic health-record applications
Working knowledge of Microsoft Office
Ability to perform basic arithmetic and interpret rates, ratios, percentages, and graphs
Ability to solve practical problems and interpret written, oral, diagram, or schedule-based instructions
Bilingual English/Spanish preferred

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Prescription coverage
Life insurance
Long-term disability
EAP (Employee Assistance Program)
Paid time off starting at 24 days per year
10 paid holidays
401(k)/retirement options
Opportunity for advancement
Culturally diverse work environment