MOUD Outreach Navigator: Hospital-to-Home Coordination

Description Title: Outreach MOUD Care Navigator Location: REACH Belltown Schedule: Monday-Friday 8:30am-5:00pm Salary Range: $82,500-$96,500 The posted salary range represents the full compensation band for the position. New hires are typically placed at the base of the range, plus up to $2,000 total for bilingual skills and/or higher education. Working at Evergreen Treatment Services makes a big difference in our community! ETS has been working to transform the lives of individuals and their communities through innovative and effective addiction and social services in Western Washington for over 50 years. Learn more about our mission and values. Change begins within. We strive to foster and sustain a diverse and inclusive community within our organization. Find out how we are working to achieve racial equity, health equity, and community justice. Our Clinic Services and REACH teams bring critical professional expertise and heartfelt compassion to the work they do every day to serve our most vulnerable community members. Check out the compelling stories told by our patients, clients, and staff members that provide more information and a clear picture regarding our organization’s essential work. REACH Mission and Values The REACH Program of Evergreen Treatment Services works with individuals experiencing homelessness and behavioral health conditions to help them achieve stability and improved quality of life. The REACH mission is to foster community health and safety through outreach, relationship, healing interventions and systems advocacy for people who use drugs. REACH provides outreach-based-care coordination, multidisciplinary clinical services, and supports to access and maintain housing. All services are based in principles of harm reduction that offer respect and dignity to individuals moving through stages of change in their lives. REACH incorporates a racial equity lens that includes naming the impact and actively dismantling systems of oppression rooted in White Supremacy, while addressing the root causes perpetuating historical trauma and immense suffering in individuals’ lives. We are committed to building a robust behavioral health response that diverts people away from jail by rebuilding community and providing services to ensure those presently marginalized aren`t just surviving, but able to thrive. REACH offers an array of services ranging from survival support provided where folks are living outside to linkages to essential resources such as housing, assistance to resolve legal issues, health care, entitlements and easily accessible treatment for substance use disorders and mental health conditions. The REACH team is passionate about creating a hospitable and welcoming environment for all people while providing quality services on an individually tailored basis to our clientele. REACH values diversity of lived experience, is committed to racial equity and social justice, and appreciates hard work, creativity, and a good sense of humor. People who have been impacted by the criminal legal system are encouraged to apply. This dynamic position plays an important role in helping ETS accomplish our mission! About the Linkage to Care Program The REACH Care Navigator roles support ETS’ mission by providing care coordination, outreach, engagement, and case management services to adults experiencing behavioral health challenges, homelessness, and substance use disorders. Despite expanded MOUD availability in King County, significant access barriers persist. The ETS-REACH Linkage to Care program addresses rising overdose rates by connecting individuals with opioid use disorder, identified in hospital settings, to MOUD treatment and harm reduction services. Care Navigators strengthen hospital and clinic-based coordination, extend the continuum of care, and support ongoing retention and re-engagement in treatment. Job Summary The Outreach MOUD Care Navigator partners with the Harborview-based Care Navigator to identify, engage, and support patients with OUD, providing harm reduction services and ensuring warm handoffs to MOUD care upon discharge. This role builds rapport prior to discharge and delivers short-term, targeted case management to address barriers to MOUD initiation and retention, including re-engagement for those who have disengaged. The Navigator participates in the Care Navigation Hub and contributes to program data collection, reporting, and system coordination efforts. Work is split between Harborview, community and street-based settings, including ETS clinics, REACH, shelters, and partner sites (e.g., DESC ORCA Center). The role also supports REACH and partner initiatives (e.g., Health 99 LAI buprenorphine popups), providing intensive outreach and short-term case management for individuals with complex health and social needs to improve MOUD linkage and early retention. The position contributes to identifying system barriers affecting engagement; early MOUD retention is often unstable, and sustained outcomes improve with continued engagement and adequate supports. Schedule: Monday–Friday, 8:00 a.m. – 5:00 p.m. Position is based out of REACH’s Belltown office but requires frequent travel to all REACH and partner sites. Responsibilities Outreach Engagement & Relationship Building Receive warm handoffs from the Harborview-based Navigator and initiate engagement prior to discharge. Build rapport with high-risk individuals and conduct outreach in community settings (street, shelter, clinic) to engage and re-engage participants post-discharge. In addition to Harborview partnership, respond to referrals from REACH staff and partners (e.g., Public Health Street Medicine, ETS-TIM, DESC ORCA) for MOUD linkage support. Rapid Linkage to MOUD Care Coordinate and support direct transport from Harborview to MOUD providers immediately upon discharge. Facilitate seamless handoffs to community-based treatment and maintain close follow-up during early engagement. Short-Term Case Management & Retention Support Provide focused, short-term case management to address immediate barriers to MOUD engagement, including transportation, housing instability, communication access (phones), insurance, and co-occurring health needs. Develop practical care plans to support stabilization beyond the first visit and proactively reengage participants who disengage. Harm Reduction & Patient Education Deliver harm reduction education and supplies in community settings, including overdose prevention, naloxone distribution, safer use & recovery strategies. Support participants in understanding MOUD options and navigating treatment in a low-barrier, patient-centered manner. Collaboration & Care Coordination Partner closely with the Harborview-based Navigator to ensure continuity across hospital and community settings. Coordinate with MOUD providers, REACH teams, shelters, and partner organizations to align care plans and reduce service gaps. Participate in case conferencing and cross-system collaboration to improve linkage and retention outcomes. Documentation, Data & Systems Improvement Document outreach, care coordination, and client engagement activities in required systems. Identify and elevate systemic barriers impacting MOUD access and retention to support program and system-level change. Note: New and/or different duties and responsibilities may be assigned to this job at any time. Qualifications Education and/or Relevant and Lived Experience (if applicable): High School Diploma or GED required; additional education preferred. Academic training in social services, substance use disorder, and mental health treatment desired. Lived experience is highly desirable and may substitute for some educational requirements if relevant project management and/or effective team-building experience is demonstrated and reflected in work history. Minimum of three years of experience in social work, outreach programs, or a related field. Knowledge of the medications used to treat opioid use disorder (e.g. methadone, buprenorphine, etc.) and ability to offer options counseling related to this service adapted to an individual’s stage of change. Experience providing services from a harm reduction perspective to individuals experiencing behavioral health challenges is highly desirable. Knowledge and Skills Have an understanding of racial justice and social equity and a commitment to helping create an equitable environment for all ETS clients and patients as well as fellow staff. Ability to establish and maintain effective working relationships with clients, patients, and staff from a wide variety of ethnic, socioeconomic, and cultural backgrounds. Strong interpersonal skills and verbal/ written communication skills. Ability to adhere closely to specific communication guidelines established by the ETS Communications Department concerning all interactions with partner organizations. Excellent organizational skills and ability to prioritize workload, work independently, and complete tasks timely and efficiently. Dependable, able to work under pressure, receptive to change, willingness to learn, cooperative approach to problem solving. Flexible team player, with excellent attention to detail. Ability to maintain confidentiality and use discretion when handling highly sensitive information. Adhere to all the confidentiality requirements and guidelines outlined in the 42 CFR, Part 2 federal regulations pertaining to SUD treatment records. Ability to set boundaries, resolve conflict and de-escalate issues. Computer literate, with basic knowledge of Microsoft Office Suite, as well as a high level of initiative in keeping current with technological change. Additional Essential Information Physical Conditions and Requirements: The employee may be exposed to illicit drug residues and fumes or other bio-hazardous materials when carrying out job functions. There is also potential for exposure to bloodborne pathogens. ETS will provide employees with appropriate training to limit the risk of exposure to bloodborne pathogens. Policies and procedures are in place addressing each item specifically. The employee is regularly required to sit; use hands to finger, handle or feel objects, tools, or controls; reach with hands and arms and talk or hear; frequently required to stand, walk, and kneel; occasionally to climb balance, or stoop; rarely to crouch or crawl. The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities required by this job include close, color, and peripheral vision and the ability to adjust focus. The noise level in the work environment is moderate. Must be comfortable working within outside agency locations, such as hospitals, community centers, shelters, clinics, and/or other partner organizations. Equipment Used: Computer, photocopier, fax machine, phone, and appropriate equipment in hospital setting. Use of a program vehicle, for which a valid Driver’s License and acceptable driving will be required. Note that a driving record background check will occur initially and at periodic intervals. Inclusivity and Reasonable Accommodation Evergreen Treatment Services is an Equal Opportunity Employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status. Note that a Washington State Patrol criminal background check will be conducted periodically as a condition of ongoing employment, and candidates with prior criminal convictions will be invited to provide additional context as needed. ETS will reasonably accommodate qualified individuals with a disability so that they can perform the essential functions of a job unless doing so causes a direct threat to these individuals or others in the workplace and the threat cannot be eliminated by reasonable accommodation, or if the accommodation creates an undue hardship for ETS. We also seek to provide reasonable accommodation for the interview process. #J-18808-Ljbffr