Intensive Support Coordinator

HOPE Atlanta; Atlanta (GA); On-site; USD 42,000 - 64,000; Full time

Job summary

HOPE Atlanta seeks an Intensive Support Coordinator to provide case management and peer support, ensuring trauma-informed, person-centered care. You’ll work with the on-site Behavioral Health Clinician and PSH team to help residents maintain wellness, pursue housing stability, and improve economic mobility.

The role leverages lived experience with recovery from mental health, substance use, or housing instability to mentor residents, connect them to resources, and support long-term success.

Qualifications

• Bachelor’s degree in social work or related field.
• Minimum of 2 years’ experience.
• Lived experience with recovery encouraged.

Responsibilities

• Conduct needs assessments to identify service gaps.
• Serve as liaison between clients and on-site clinician.
• Collaborate on treatment and recovery plans based on peer experience.
• Help clients access community resources, including care, employment, benefits, and other services.
• Coordinate with the clinician to follow up on referrals and timelines.
• Support clients in completing housing, benefits, healthcare paperwork.
• Assist clients in adhering to housing agreements and stability plans.

Skills

Peer perspective

Case management

Trauma-informed care

Cultural competence

Communication

Resource navigation

EHR proficiency

Driver's license

Education

Bachelor's degree in social work

Tools

MS Office

ClientTrack

EHR systems

Job description

The Intensive Support Coordinator provides case management and peer support to ensure clients receive comprehensive, person-centered, trauma-informed care. Working closely with the on-site Behavioral Health Clinician and the interdisciplinary PSH team, the Intensive Support Coordinator supports residents in maintaining wellness, achieving housing stability, enhancing economic mobility, and reaching personal recovery goals.

This role leverages lived experience with mental health recovery, substance use recovery, and/or housing instability to engage residents, provide mentorship, and connect them to the resources and supports necessary for long-term success.

Essential Duties and Responsibilities

• Conduct needs assessments to identify service gaps or areas requiring additional support.
• Serve as a liaison between clients and the on-site clinician to ensure client needs, concerns, and preferences are communicated.
• Collaborate with the on-site clinician to provide input on treatment and recovery plans based on peer experience and client engagement.
• Help clients connect to community resources, including primary care, behavioral health care, employment services, benefits programs, and other supportive services.
• Coordinate with the clinician to follow up on referrals and ensure clients receive timely access to services.
• Support clients in completing required paperwork for housing, benefits, healthcare, and related services.
• Assist clients in adhering to housing agreements and connect them to appropriate support to promote long-term housing stability.

Crisis Support & Conflict Resolution

• Assist in de-escalating situations using peer-level communication, grounding strategies, and problem-solving approaches.

Documentation & Compliance

• Maintain accurate, timely documentation of peer support services, recovery plans, case management tasks, and all client interactions in accordance with agency standards.
• Ensure compliance with confidentiality laws and ethical peer-support practices.
• Participate in ongoing training to remain current with best practices in peer support, trauma-informed care, case management, and Housing First principles.
• Engage in regular supervision with the on-site clinician and/or Clinical Director to discuss client progress, challenges, and professional development.
• Provide one-on-one support to help clients identify, set, and work toward recovery, wellness, and housing stability goals.
• Share lived experiences with mental health or substance use recovery to inspire hope and model positive pathways to wellness.
• Facilitate groups focused on recovery, wellness, life skills, and housing stability.
• Promote wellness practices including relapse prevention strategies, coping skills, self-care, and strengths-based support tailored to individual needs.

Advocacy & Empowerment

• Empower clients to advocate for themselves during service planning, housing meetings, and treatment discussions.
• Assist clients in understanding and exercising their rights within behavioral health, housing, and supportive service systems.
• Support clients in navigating community resources, healthcare systems, benefits, and housing services.
• Accompany clients to appointments and meetings as needed, offering guidance, emotional support, and advocacy.

Additional Duties and Responsibilities:

This job description provides a general overview of responsibilities and is not an exhaustive list of duties, skills, or working conditions. Tasks may be revised, added, or removed based on program needs and the agency’s mission.

Qualifications

• Bachelor’s degree in social work or related human services field.
• Minimum of 2 years’ experience

Skills and Abilities

• Strong understanding of mental health and addiction recovery from a peer perspective, including wellness strategies and self-advocacy.
• Knowledge of case management processes, resource navigation, and service coordination.
• Ability to engage and support clients using trauma-informed, person-centered, and culturally responsive approaches.
• Effective communication, problem-solving, and conflict-resolution skills that support empowerment and self-determination.
• Willingness to use lived experience appropriately to encourage and support others in recovery.
• Commitment to the mission, values, and service approach of HOPE Atlanta.
• Ability to work effectively with diverse populations, including individuals from varied cultural, ethnic, and socioeconomic backgrounds.
• Proficiency with electronic health record (EHR) systems, MS Office Suite, Homeless Management Information Systems (e.g., ClientTrack), and other databases.
• Valid Georgia driver’s license, good driving record, and reliable transportation required.