Social Worker-Coordinated Entry, Triage, & Care Coordination

St Mary's Center•Emeryville, CA

4d•$85,000 - $95,000•Hybrid

About The Position

St. Mary's Center is a community of hope, healing and justice dedicated to improving the well-being of Seniors and Preschool Families in West Oakland by meeting basic needs for food, housing, and social connection. We build on a strong foundation of direct service provision and participant-led advocacy that amplifies the voices of people directly impacted by hunger, homelessness, and inequity to create a more just and caring society. Today, our staff of 40 provides Senior Homeless and Housing Services, including case management and housing clinics; transitional housing at multiple sites; and a vibrant Community Center offering hot meals, social connection, and leadership development. We are partnered with a local nonprofit developer to build and service 73 new homes for Seniors near our headquarters. The Social Worker – Coordinated Entry, Triage & Care Coordination serves as the primary assessment and triage specialist for Senior Housing Services. This position is responsible for Housing Clinic assessments, Coordinated Entry activities, participant prioritization, care coordination, crisis screening, and recommendations regarding housing interventions and supportive services. The Social Worker serves as the primary entry point into housing services and ensures participants are appropriately connected to Housing Navigation, Transitional Housing, Tenancy Sustaining Services, healthcare, behavioral health, and community resources. The position does not typically carry an ongoing housing case management caseload and instead focuses on assessment, triage, care coordination, and participant access.

Requirements

Master’s Degree in Social Work (MSW) or related field.
Registration as an ASW or eligibility for registration preferred.
Three years of experience in homelessness services, housing services, behavioral health, healthcare, or supportive services.
Experience conducting assessments and care coordination.
Experience working with vulnerable populations.
Valid California Driver’s License.

Nice To Haves

Licensed Clinical Social Worker (LCSW).
Experience with Coordinated Entry, HMIS, Housing First, and CalAIM.
Experience serving older adults experiencing homelessness.
Bilingual or multilingual skills.

Responsibilities

Conduct Coordinated Entry assessments and reassessments.
Complete housing needs assessments.
Evaluate participant eligibility for housing programs.
Assess barriers to housing stability.
Determine housing intervention recommendations.
Support participant prioritization and referral activities.
Ensure compliance with Alameda County Coordinated Entry requirements and contractual obligations.
Conduct participant assessments during Housing Clinic.
Review participant housing needs and service requests.
Provide recommendations regarding housing pathways.
Support participant engagement and navigation.
Coordinate referrals into Housing Navigation and Transitional Housing programs.
Conduct crisis screening and risk assessments.
Coordinate referrals to healthcare, behavioral health, substance use, APS, IHSS, ECM, and supportive services.
Facilitate warm handoffs to internal and external service providers.
Assist participants in accessing appropriate community resources.
Support participant-centered service planning.
Participate in multidisciplinary case conferences.
Consult with Housing Services staff regarding participant needs.
Collaborate with the external partners regarding high-risk participants.
Assist with complex participant situations and service planning to ensure closed loop referrals and quality follow-up.
Participate in Coordinated Entry and regional meetings.
Maintain relationships with referral partners.
Coordinate participant referrals across systems of care.
Maintain timely HMIS and Salesforce documentation.
Complete assessment and referral documentation.
Support quality assurance activities.
Ensure compliance with program requirements and documentation standards.