Field-Based Complex Care Coordinator for High-Risk Patients

Boston Health Care for the Homeless Program; Boston (MA); On-site; USD 30,000 - 48,000; Full time

Benefits offered by this job

Time off program

Health/dental/vision insurance

403B retirement savings plan

MBTA pre-tax pass program

Job summary

Boston Health Care for the Homeless Program is seeking a Complex Care Coordinator to support high‑risk primary care patients across BHCHP clinics and mobile outreach. You will coordinate care with primary care teams, case managers, and community partners to improve engagement for a medically complex, largely homeless population.

The role involves clinic-based work at Woods Mullen Shelter and outreach to other women’s health sites, with a focus on care coordination, documentation, and

Qualifications

• Bachelor’s degree in behavioral health field or related area.
• Able to work with multidisciplinary team maintaining good rapport with staff and patients.
• Strong problem solving and communication skills (written and oral).
• Excellent customer service and professional communication.
• Organized, detail-oriented, and able to manage tasks in time-sensitive settings.
• Spanish or Haitian Creole language skills strongly preferred.
• Willingness to travel to outreach sites; valid driver’s license and car recommended to travel to multiple sites.

Responsibilities

• Work in assigned clinics with a multidisciplinary team.
• Combine scheduled sessions with outreach as needed, with supervisor approval.
• Document patient encounters and outreach in the electronic health record.
• Develop and document patient goals and plan of care for each patient.
• Coordinate services addressing housing, transportation, and other social needs.
• Support access to public health supplies and assist with HMIS initiatives.
• Develop awareness of community resources and promote appointment adherence.
• Support referrals to SUD programs and coordinated care across sites.

Skills

Problem solving

Communication skills

Customer service

Multidisciplinary collaboration

Spanish language

Haitian Creole language

Travel willingness

Education

Bachelor’s degree in behavioral health field

Tools

Microsoft Excel

Job description

Boston Health Care for the Homeless Program is seeking a Complex Care Coordinator to support high‑risk primary care patients across BHCHP clinics and mobile outreach. You will coordinate care with primary care teams, case managers, and community partners to improve engagement for a medically complex, largely homeless population.

The role involves clinic-based work at Woods Mullen Shelter and outreach to other women’s health sites, with a focus on care coordination, documentation, and