Care Coordinator - Re-Entry Services

Greater Lawrence Family Health Center•Lawrence, MA

33d•Hybrid

About The Position

The Care Coordinator is responsible for providing comprehensive, culturally responsive care coordination and linkages to services for women, pre- and post-release from incarceration, as well as for those under community supervision. This role includes utilizing community resource knowledge and cultural awareness in addition to a broad range of services and supports according to the expressed needs of the participants and their individualized service plans and goals. The Care Coordinator will collaborate with the primary care team to engage clients in meaningful reentry services to reduce relapse and recidivism. Engagement efforts should begin six months before release in partnership with the HOC and other stakeholders. This is a grant-funded position.

Requirements

Valid Massachusetts Driver's license and reliable transportation.
Able to communicate effectively verbally and in writing
Demonstrated computer skills (Microsoft Outlook, Excel, and Word).
Strong communication skills, both interpersonal and well-written documentation.
Takes initiative, strong problem-solving abilities, attention to detail, ability to follow through, excellent communication abilities, ability to work under pressure, meet inflexible deadlines, and set priorities.
Knowledge of recovery systems, substance use disorder, treatment facilities, and Naloxone education.
Experience working with priority populations, including Persons Who Inject Drugs, Substance Use Disorder, and incarcerated individuals.
Strong knowledge of substance use, HIV, STIs, and HCV and its transmission and prevention and community resources.
Bilingual, bicultural (Spanish/English) required.

Nice To Haves

Three years of experience in case management/ care coordination is preferred
Experience in community-based service delivery is preferred
Degree in Human Services or Public Health preferred, or a combination of education and experience will be considered.
Community Health Worker Certificate or must complete within 12 -18 months of hire.
Recovery Coach certification preferred or must complete within 12-18 months of hire.

Responsibilities

Conduct client intakes at the House of Corrections (HOC), Women in Transition, and Link House Inc.
Provide reentry support and case management for clients post-release.
Develop and maintain individualized service plans (ISPs).
Facilitate care coordination, including referrals to medical, behavioral health, and social services.
Support clients with housing, employment, transportation, and community reintegration services.
Provide trauma-informed, culturally responsive support, including substance use wellness, harm reduction, and recovery services.
Serve as a liaison between clients and court-mandated programs, HOC staff, and community partners.
Participate in case conferences, presentations, and collaborative meetings with internal and external stakeholders.
Link clients to Medication for Opioid Use Disorder (MOUD), detox services, and low-threshold interventions for people who use drugs (PWUD).
Assist clients with accessing and navigating community services, completing forms, and overcoming barriers to care.
Stay current on trauma-informed practices, overdose prevention, addiction treatment, and culturally appropriate care.
Provide linguistic support and assist clients with language or literacy needs.
Collaborate closely with other departments, providing regular updates on client progress.
Track data, complete documentation, and support reporting to funders and program leadership.
Participate in quality improvement initiatives and regular supervision.
Travel between sites as needed; hybrid remote work and occasional after-hours availability may be required.