Referral Coordination Associate - Social Care Networks

Anthos Home•New York, NY

5d•$55,000 - $57,000•Hybrid

About The Position

We are seeking a Referral Coordination Associate – SCN to support Anthos|Home’s participation in New York State Social Care Networks (SCNs) under the 1115 Medicaid Demonstration Waiver and Anthos|Home’s partnership with NYC Health + Hospitals (H+H) Housing for Health program. This role supports referral management, participant intake and assessments, documentation coordination, and early-stage navigation of housing and health-related social needs (HRSN) services. Serving as a primary point of contact for SCN and H+H referrals, the Referral Coordination Associate works directly with participants, healthcare partners, and internal Anthos|Home teams to ensure timely intake, accurate data entry, and coordinated service navigation. This position involves direct participant contact, use of multiple data systems, and collaboration with Managed Care Organizations, Health Homes, hospital staff, and community-based partners. The Associate will work closely with senior staff to build skills and navigate complex workflows.

Requirements

Bachelor’s degree in a related field and/or relevant experience in housing coordination, case management, public health, or human services; 0–2 years of experience preferred.
Some exposure to or interest in Medicaid populations and/or health-related social needs (HRSN) screenings or assessments.
Strong organizational, documentation, and time-management skills, with the ability to balance multiple workflows.
Excellent verbal and written communication skills and strong interpersonal skills.
Comfort learning and working across multiple data systems; prior experience with Salesforce, Microsoft Excel, MEVS, ePACES, or GHIT is a plus, but not required.
Ability to follow established processes, maintain accurate records, and support data-informed decision-making.
Demonstrated commitment to Anthos|Home’s mission and ability to work effectively in a diverse, mission-driven environment.

Nice To Haves

Familiarity with NYC housing systems, subsidies, and voucher programs (e.g., CityFHEPS, Section 8, SHARE) a plus.

Responsibilities

Receive, track, and manage referrals from Social Care Networks and NYC Health + Hospitals Housing for Health.
Conduct outreach to referred participants by phone and in person, as appropriate.
Screen participants for Medicaid eligibility and unmet HRSN using the Accountable Health Communities HRSN Screening Tool.
Confirm participant identity and Medicaid enrollment using MEVS or ePACES with support from senior staff.
Collect participant consent, attestations, and required documentation.
Conduct housing and service assessments, including in-person assessments for H+H referrals and remote assessments for SCN referrals.
Confirm participant eligibility and interest in enhanced HRSN and housing services.
Support development of care plans and coordinate referrals to housing and other HRSN services.
Assist in connecting participants with healthcare providers, shelters, service providers, and internal teams.
Maintain accurate, timely, and confidential records in SCN IT platforms, the General Housing Intake Tracker (GHIT), and Anthos|Home’s Salesforce system.
Track referral progress, housing status, and service milestones in accordance with program requirements.
Submit required billing and service documentation through SCN IT platforms.
Ensure all documentation meets Anthos|Home, Medicaid, SCN, and H+H compliance standards.
Collaborate with Tenant Coordination, Operations, Housing Navigation, and Aftercare teams to support smooth transitions from intake through housing placement.
Provide trauma-informed, culturally responsive, and participant-centered support throughout the intake and assessment process.
Identify and flag intake barriers or workflow issues to senior staff that may impact participant progress or service delivery.
Perform other related duties as assigned in support of program and organizational needs.