Case Manager, Safe Options Support (SOS)

Acmh; New York (NY); On-site; USD 60,000 - 73,000; Full time

Job summary

ACMH in New York is seeking a Case Manager for Safe Options Support (SOS) to conduct street-to-home outreach, coordinate housing placement, and advocate for clients facing discrimination or healthcare inequities. The role emphasizes collaborative care, data reporting, and ongoing support to improve outcomes.

Responsibilities include health and social needs assessments, housing application assistance, hospital discharge collaboration, and post-housing support with navigation and care plan

Qualifications

• Bachelor’s degree or higher in psychology, social work, sociology or related field.
• New York State LPN license also acceptable.
• Past case management experience in social services is preferred.

Responsibilities

• Outreach and engagement with homeless or precariously housed individuals.
• Assess health and social needs using SOS assessments and risk tools.
• Help identify housing options, assist with applications, and support moving in.
• Participate in hospital discharge planning to connect clients with community resources.
• Collect and report data to inform future care delivery.
• Support participants post-housing to address clinical issues and barriers to care.
• Coordinate with community providers to link services and ensure continuity of care.
• Arrange appointments and provide travel/navigation support.
• Review documentation to determine medical, psychiatric, housing and social needs.
• Obtain information from multiple sources to support health and behavioral needs.
• Monitor and document progress toward care plan goals.
• Attend team meetings and supervision sessions.

Skills

Counseling knowledge

Communication skills

Documentation skills

Data collection & reporting

Collaboration

Education

Bachelor’s degree or higher (psychology / social work / related)

New York State Licensed Practical Nurse (LPN)

Related field background

Tools

Electronic health records (EHR) systems

Microsoft Office

Job description

Description

Position: Case Manager, Safe Options Support (SOS)

Function: Community outreach on the streets and subways, coordinating participants needs before and after their move from street to home, enhancing their daily living skills, providing supportive counselling, and advocating on their behalf when faced with discrimination or healthcare inequities.

Reports to: Team Leader, SOS

Schedule: Sundays (9:00am-5:00pm) and Mondays through Thursdays (7:00am-3:00pm)

Job Responsibilities

• Persistent and assertive outreach and engagement using strength-based approaches beginning either at known “hang-outs” or “Hot spots” within the transit system or during an inpatient hospital admission or emergency department visit;
• Continuously assess the health and social needs of participants through SOS’s conversational and observational assessments and formalized risk assessments tools for those identified as being at high risk;
• Work in collaborations with the centralized SOR Hub to identify available housing and to support participants through the process. Tasks may include completing HRA 2010e, applying for housing, prepping for interviews, follow up with housing providers, and assistance with moving in (day of move) with obtaining housing supplies and learning the neighborhood;
• Participate in hospital discharge planning meetings to identify the best community resources for returning patients;
• Collects and reports data, as required and work with team leader, data analyst and other SOS teams to use data to inform future care delivery;
• Once housed work with participants and their housing providers to resolve clinical issues that are impacting on the participant’s ability manage, and retain supportive housing;
• Foster relationship with community provides to ensure that recipients are connected with appropriate services as they transition back into the community;
• Appointment navigation including accompaniment to appointments, travel training, reengagement in community care, and addressing barriers to care;
• Review documentation and conduct comprehensive psychosocial assessments to determine the medical, psychiatric, housing and other social needs in the community;
• Obtain historical and collateral information from multiple sources to support participants behavioral and physical health needs;
• Monitor, evaluate and record participants progress with respect to care plan goals;
• Attend and participate in team meetings and supervisory sessions.
• Perform other related duties as assigned.

Essential Knowledge, Skills and Abilities

• Experience working with homeless and/or precariously housed populations preferred but not required;
• Knowledge of homeless resources, NYC shelter systems, and MTA transit systems a plus.
• Knowledge of counseling principles and methods for mental illness and substance use disorders;
• Knowledge of treatment, rehabilitation, and community support programs as they relate to recipient/residents, families, and staff;
• Ability to develop, evaluate, implement, and modify treatment intervention to meet the needs of individual recipients;
• Ability to prepare accurate and timely reports;
• Computer proficiency and good documentation skills.

Requirements

Bachelor’s degree or higher, preferable in psychology, social work, sociology, or related field or be a New York State Licensed Practical Nurse (LPN). Case Management work experience in a social service agency, preferable serving a behavioral health population. Four years of past work case management work experience may be considered in lieu of Bachelor’s degree.

Salary: $66,294 plus generous benefits

ACMH is committed to the mental and physical wellbeing of vulnerable New Yorkers and is a leader in the provision of outreach and engagement, care management, rehabilitation, crisis support, and supportive housing. ACMH is committed to becoming an anti-racist organization and seeks to promote actionable change to create an intentional culture of equity at individual, interpersonal and institutional levels.

For more information, visit our website: www.acmhnyc.org

ACMH is an equal opportunity employer and does not discriminate in employment decisions based on race, color, creed, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, mental or physical disability, marital status, veteran status or citizenship status.