Hospital Outreach Care Coordinator

BRC - Bowery Residents' Committee, Inc.; New York (NY); On-site; USD 55,000 - 65,000; Full time

Benefits offered by this job

Health insurance

Paid time off

403(b) retirement plan

Tuition assistance

FSAs

Legal and personal support resources

Job summary

BRC - Bowery Residents' Committee, Inc. is hiring for a Hospital and Care Coordination role in New York City.

This field-based position coordinates hospital discharge planning, supports medically vulnerable clients, and ensures continuity of care through engagement with hospitals, shelters, and Safe Haven sites. Responsibilities include coordinating with hospital teams, conducting field outreach, documenting client interactions, and managing grant reporting requirements.

Qualifications

• Medical assistant certification or equivalent experience.
• Associate's or Bachelor's degree required, or demonstrated equivalent experience.
• 1–2 years experience in homeless services, healthcare coordination, or related fields.
• Strong interpersonal, communication, and organizational skills.
• Ability to travel throughout New York City, including hospitals, shelters, Safe Haven programs, and other community locations.
• Proficiency with Microsoft Office and electronic documentation systems.

Responsibilities

• Coordinate discharge planning with hospital social workers, care managers, discharge planners, and medical teams.
• Coordinate movement of patients between hospital facilities and Safe Haven programs or other housing settings.
• Ensure safe transfers and coordinate necessary services for patient needs.
• Conduct in-person hospital visits to meet clients prior to discharge.
• Collaborate with outreach teams to ensure continuity of care after discharge.
• Assist clients with attending medical appointments, obtaining medications, and securing equipment.
• Monitor follow-up care for medically complex and high-vulnerability clients.
• Identify urgent medical, psychiatric, or social service concerns and elevate appropriately.
• Maintain accurate and timely documentation of client interactions, referrals, placements, and outcomes.
• Track grant deliverables, program metrics, and reporting data.

Skills

Interpersonal communication

Organizational skills

Microsoft Office

Electronic documentation systems

Ability to travel

Education

Associate's or Bachelor's degree

MSW (preferred)

LPN (preferred)

Tools

Microsoft Office

Electronic Health Records (EHR)

Job description

At BRC, we help New Yorkers experiencing homelessness reclaim their lives with opportunities for health, self-sufficiency, and hope, while restoring dignity and respect. We invest in our employees through growth, learning, and meaningful work across Manhattan, Brooklyn, the Bronx, and Queens , offering a wide range of benefits and a supportive team environment . Join our passionate team, make a real difference every day, and be part of a community that’s building a more caring and compassionate city.

Role Overview

The Hospital and Care Coordination position is responsible for coordinating hospital discharge planning, facilitating client placements into Safe Haven and other housing settings, conducting field-based outreach, supporting medically vulnerable clients through healthcare navigation and follow-up care, and maintaining accurate documentation and grant reporting to ensure continuity of care and program compliance.

Key Responsibilities

Hospital and Care Coordination

• Coordinate discharge planning with hospital social workers, care managers, discharge planners, and medical teams.
• Coordinate the movement of patients between a hospital or skilled nursing facility and Safe Haven programs and other appropriate housing or shelter settings.
• Ensure a safe transfer to a setting that meets the patient's needs and coordinates necessary services and staff required to complete the transfer.
• Conduct in-person hospital visits to meet with clients prior to discharge and support transition planning.
• Collaborate closely with outreach teams to ensure continuity of care and engagement after discharge.
• Assist clients in attending medical appointments, obtaining medications, securing medical equipment, and understanding discharge instructions.
• Monitor and support follow-up care for medically complex and high-vulnerability clients.
• Identify urgent medical, psychiatric, or social service concerns and elevate appropriately.

Outreach and Client Engagement

• Conduct field-based outreach throughout New York City, including street engagement and visits to hospitals, shelters, and Safe Haven sites.
• Build rapport with individuals experiencing homelessness using trauma-informed and client-centered approaches.
• Support clients with healthcare navigation, benefits access, transportation coordination, and appointment scheduling.
• Maintain communication with multidisciplinary providers, including hospitals, behavioral health providers, outreach teams, and shelter staff.

Administrative and Grant Management Duties

• Maintain accurate and timely documentation of client interactions, referrals, placements, and outcomes.
• Track grant deliverables, program metrics, and required reporting data.
• Manage program-related email communication with hospitals, providers, and internal teams.
• Assist with data collection, quality assurance, and reporting requirements related to grant funding.
• Provide day-to-day administrative support, maintain organized records while ensuring compliance with confidentiality and HIPAA-related standards.
• Support program leadership in identifying trends, service gaps, and opportunities for improved coordination.

Required Qualifications

• Medical assistant certification, healthcare training, EMT experience, nursing support experience, or similar medical background required.
• Associate's or Bachelor's degree required, or demonstrated equivalent experience in lieu of a degree.
• Minimum of 1–2 years experience in homeless services, healthcare coordination, hospital discharge planning, outreach, case management, or related fields.
• Strong interpersonal, communication, and organizational skills.
• Ability to work independently and effectively in both office and field settings.
• Proficiency with Microsoft Office and electronic documentation systems.
• Ability to travel throughout New York City, including hospitals, shelters, Safe Haven programs, and other community locations.

Preferred Qualifications

• Licensed Practical Nurse (LPN).
• Master of Social Work (MSW).
• Medical Assistant or candidates with strong medical assistant experience.
• Experience working with individuals experiencing homelessness, behavioral health needs, or other vulnerable populations.
• Experience coordinating care with hospitals, healthcare providers, or community-based organizations.
• Knowledge of HIPAA and client confidentiality standards.
• Familiarity with New York City's homeless services system, healthcare systems, and community resources.
• Experience using trauma-informed, person-centered, and harm reduction approaches.

Working Conditions

This is a field-based position requiring regular travel to hospitals, outreach locations, Safe Haven programs, and community settings throughout New York City. The role involves engagement with medically and socially vulnerable populations in both indoor and outdoor environments.

Schedule

Full-time position. Working hours are from 8:30am-5pm. Schedule may include occasional evenings or flexibility based on hospital discharge coordination and outreach needs.

• Competitive health and dental plans, with coverage available for your spouse, domestic partner, and dependents
• Minimum of 3 weeks paid vacation, 12 paid holidays, plus additional paid sick and personal time
• 403(b) retirement plan with BRC matching contributions
• Tuition assistance and a variety of career development and training opportunities
• Flexible Spending Accounts (FSAs) for healthcare, transit, and childcare expenses
• Free resources for legal, financial, and personal support

Pay Rate

$55,000-$65,000

Schedule

Monday-Friday 8:30am-5pm

Experience Level

Mid-Level

Shift

Day

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