Team Coordinator/Sr. Case Manager

Boston Health Care For The Homeless Program • Boston, MA

5d • $24 - $38

About The Position

Since 1985, BHCHP's mission has been to ensure unconditionally equitable and dignified access to the highest quality health care for all individuals and families experiencing homelessness in greater Boston. Over 10,000 homeless individuals are cared for by Boston Health Care for the Homeless Program each year. We are committed to ensuring that every one of these individuals has access to comprehensive health care, from preventative dental care to cancer treatment. Our clinicians, case managers, and behavioral health professionals work in more than 30 locations to serve some of our community's most vulnerable—and most resilient—citizens. From our earliest days as a program, we have always sought to do work that is transformational: recognizing our shared humanity; centering dignity, compassion, mutual respect and supporting the right of every individual to access the highest levels of health care and every staff member to reach their fullest potential. We continue to be committed to building bridges and breaking down barriers, including systemic racism which harms us all. We provide community-based health care services that are compassionate, dignified, and culturally appropriate, incorporating social determinants of health, with the goal of breaking down the physical and systemic barriers that our patients face. Hours: Full Time, Monday - Friday 8:30am - 5:00pm Union: Yes Union Name: 1199 SEIU Patient Facing: Yes Our doctors and nurses do heroic work every day, caring for some of the most vulnerable members of our community. Yet true healing often requires more than clinical care alone—it takes connection, coordination, and compassion beyond the exam room. To meet this critical need, we are excited to introduce a new, non-clinical, two-part role on our Street Team. This position combines complex case management within the Behavioral Health Community Partners (BH CP) care management program with leadership responsibilities as a Senior Case Manager. In this role, you will collaborate closely with a multidisciplinary team to support highly vulnerable, predominantly unsheltered individuals experiencing mental illness and/or substance use disorders. You will play a key role in connecting individuals to behavioral health services, primary care, and essential social determinants of health supports—helping them navigate systems, build stability, and move toward improved health and well-being. If you are driven by mission, thrive in complex environments, and want your work to make a meaningful difference every day, this is an opportunity to be part of something truly impactful.

Requirements

• To succeed in this role, you'll bring strong leadership skills and have the confidence to collaborate within a cross-sector team that is based in various locations across Boston, providing feedback regarding population health.
• You must have experience caring for underserved populations, navigating homeless/housing services and the health care system.
• Manage data reporting and monitor program metrics for the team.
• Provide as-needed staff training on core competencies.
• Lead regular BH CP team meetings; direct team flow to meet quality and program expectations.
• Team coordinator(s) shall have at minimum:
• A bachelor's degree in social work, human services, nursing, psychology, sociology, or related field; or
• An associate degree and at least one-year professional experience in the field; or
• At least three years of relevant professional experience.
• A strong commitment to harm reduction principles and trauma informed care.
• Strong problem solving and communication skills (written and oral).

Responsibilities

• In your role as BH CP Team Coordinator for the Street Team, you will oversee outreach, enrollment, and ongoing case management for our Street Team.
• Orient and train staff members to BH CP processes, requirements, and practices.
• Identify patients already empaneled to the Street Team for primary care who are appropriate for referral to the BH CP to ensure the Street Team BH CP panel remains full; support the Care Coordinator and Nurse Case Manager in outreaching referred patients for enrollment to the BH CP.
• Ensure completion of patient Comprehensive Assessment and Care Plan in a timely way and in accordance with MassHealth requirements; monitor and commmunicate your team's performance on metrics such as hospital discharge follow-up and timely care plan completion.
• Attend BH CP meetings on a monthly, weekly or as needed basis and ensure the attendance of other Street Team BH CP members.
• In your role as a Senior Case Manager on the Street Team, you will be part of an integrated and multidisciplinary team that seeks out the individuals who experience chronic unsheltered homelessness.
• As part of a team, engage with and care for patients across a variety of settings including outpatient clinic at Massachusetts General Hospital, street outreach, patients' homes and in facilities.
• Coordinate and lead monthly meetings with housing partners regarding currently housed patients empaneled to the Street Team; represent the Street Team at housing related meetings run by the City of Boston and other agencies regarding unsheltered patients empaneled to the Street Team
• Coordinate and lead 1-2 case conferences per month for high risk patients empaneled to the Street Team; coordinate and lead quarterly Street Team discussions to ensure street outreach is occurring in appropriate locations across the City of Boston.
• Assist with insurance barriers, referral for benefits, transportation, provide reminder calls for visits, and proactively contact patients to remind them about appointments; a ssist clients identify health-related social service needs, help them access related resources, and support the successful utilization of these resources.
• Document each patient encounter in the electronic medical record.
• Explicitly strive for equitable access to primary care services for chronically unsheltered patients of all races, ethnicities, and genders

Benefits

• BHCHP full time employees are eligible for our competitive time off program, health, dental and vision insurance, 403B retirement savings plan, pre-tax MBTA pass program with 40% discount, additional compensation for demonstrated bilingual proficiency and more.
• Benefits are prorated for part-time employees.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 251-500 employees