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About the Role
The Safe Operations Support (SOS) Case Manager provides comprehensive care coordination and support services to individuals experiencing homelessness. This role involves street outreach, engagement, and intensive care coordination to help individuals achieve housing stability and improve well-being. The position requires field-based work, on-call coverage, and flexible hours.
Responsibilities
- Conduct outreach to locate and engage street homeless individuals in need of immediate assistance.
- Build rapport and establish trusting relationships with individuals experiencing homelessness, providing support, empathy, and guidance.
- Connect homeless individuals with available shelter or emergency housing resources, ensuring their safety and immediate needs are addressed.
- Collaborate with community partners, including shelters and housing providers, to facilitate access to appropriate services and resources.
- Engage individuals through known locations or during hospital/ED admissions, assisting with transition planning and assessing community support needs.
- Conduct outreach to various entities (e.g., Street Outreach Teams, police, hospitals, providers, community members) to identify individuals benefiting from SOS CTI Team referral.
- Conduct individual sessions focusing on prevention and preparation for independent community living, addressing issues related to relationships, stress management, daily living, medication management, and housing readiness.
- Work with participants and housing providers to resolve clinical issues impacting housing stability.
- Foster connections with community-based organizations promoting purpose, wellness, education, employment, socialization, and community involvement.
- Engage in ongoing assessment and resolution of participants' immediate needs, including health, safety, clothing, food, income/benefits, and shelter.
- Provide community navigation, including accompanying participants to appointments, travel training, reengagement in care, and referral to services while addressing potential barriers.
- Establish collaborative working relationships with referring treatment teams and partners for appropriate participant discharges.
- Provide intensive emotional and practical support during participant transitions back into the community.
- Provide on-call after-hour crisis intervention services, including respite referrals and diversion/stabilization services.
- Respond to requests from the SOS On Call line for individuals in need.
- Attend and participate in team meetings and supervisory sessions.
- Review documentation and conduct comprehensive psychosocial assessments to determine medical, psychiatric, housing, and social needs.
- Develop short-term, person-centered care plans to assist participants in achieving their goals.
- Monitor and record participant progress, modifying plans as needed.
- Ensure timely and accurate documentation of participant information within the Health Information Technology platform.
- Develop participants' daily living skills, including personal hygiene, grooming, laundry, nutrition, meal preparation, budgeting, socialization, and maintaining a safe living environment.
- Comply with all required in-service training and staff development.
- Perform other related duties as assigned.
Requirements
- 2 years of case management work experience in a social service agency, preferably serving a behavioral health population.
- Knowledge of mental illness and the needs of individuals living with severe and persistent mental illness.
- Demonstrated competency in written, verbal, and computational skills to present and document records in accordance with program standards.
- Flexibility to work overnight hours, including weekends and holidays, as needed to ensure 24-hour coverage and support for the SOS program.
- Knowledge of mental illness, serious emotional disturbances, and substance use disorders.
- In-depth knowledge of NYC behavioral health and community support programs and systems.
- Knowledge of homeless resources, NYC shelter systems, and MTA transit systems.
- Experience working with homeless and precariously housed populations.
- Knowledge of treatment, rehabilitation, and community support programs as they relate to consumers/residents, families, and staff.
- Knowledge of multi-disciplinary team experience (preferred).
- Knowledge of techniques for identifying and preventing potentially violent behavior, including crisis management techniques.
- Ability to develop, evaluate, implement, and modify clinical treatment interventions to meet participant needs.
- Ability to prepare accurate and timely reports.
- Ability to manage multiple projects and ask for help when needed.
- Computer proficiency in Electronic Health Records and Microsoft applications (MS Word, Excel, PowerPoint).
- Ability to utilize strength-based and recovery-oriented approaches (e.g., Harm reduction, motivational interviewing, trauma-informed care).
- Ability to communicate effectively with stakeholders.
- Competency in written, interpersonal, verbal, and computational skills to present and document records in accordance with program standards.
- Familiarity with systems and tools commonly utilized across HH programs (e.g., MAPP, UAS, EMEDNY, PSYCKES) (preferred).
- Available to work a flexible schedule in response to participant and staff needs.
Skills
- Case management
- Care coordination
- Support services
- Outreach
- Engagement
- Rapport building
- Empathy
- Guidance
- Resource connection
- Advocacy
- System navigation
- Progress monitoring
- Housing stability
- Well-being improvement
- Crisis intervention
- Documentation
- Psychosocial assessment
- Care planning
- Skill building
- Harm reduction
- Motivational interviewing
- Trauma-informed care
- Communication
- Interpersonal skills
- Computational skills
- Computer proficiency
- Electronic Health Records
- Microsoft Word
- Microsoft Excel
- Microsoft PowerPoint
Location
- Community-based
Work Type
- Field-based
- On-call
- Flexible hours
Experience Level
- 2 years of case management work experience
Education Level
- Bachelor’s degree or higher in psychology, social work, sociology, or related field
- New York State Licensed Practical Nurse (LPN)