POSITION SUMMARY:

A Housing Specialist (HS) is a trusted member of the community who helps high risk patients maintain stable health and wellness with a focus on housing through integrating and connecting hospital home-based and community-based services. A HS is responsible for setting housing goals and supporting patients in achieving those to include housing navigation application process pre and post-tenancy supports service planning and eviction prevention. A HS is responsible for providing advocacy and case management services; developing an interdisciplinary care plan based on identified patient needs; facilitating access to social service resources and other internal and external resources to support housing; monitoring the patients progress; and problem-solving with patients to both accelerate and enhance access to concrete supports.

A HS provides in-home or community-based one-on-one family and/or interdisciplinary group support to high risk care patients in support of Complex Care Management Team and collaborates with the Patient Care Manager PCP and other members of the care team to conduct needs assessments to identify and respond to barriers to the patients health and wellness.

Position: Housing Specialist-1

Department: ELAHP

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Initiates face to face contact with eligible patients to describe role explain participation benefits and begin screening process.
• Schedules and completes initial hospital clinic or community-based (homes shelters housing agencies substance use treatment programs etc.) visit screening care plan and follow up visits and phone calls for enrolled patients within specified timeframes.
• Teaches key educational messages using a variety of culturally linguistically and educationally appropriate strategies in a variety of settings.
• Participates with other staff in activities that include community outreach presentations to community organizations development of materials and phone calls.
• Works with patients and Complex Care Management Team to set housing goals for patient and provides guidance for patient to achieve those goals.
• Presents patients at case review meetings succinctly and logically. Consults with Complex Care Team regarding complex patient situations demonstrating an understanding of how to solicit and incorporate provider feedback in order to continuously develop the most optimal plan for care.
• Demonstrates the ability to function within an inter-disciplinary team (nurse care coordinators social workers behavioral health clinicians physicians resource specialists clinical support staff etc.) connecting the patient with resources as needed.
• Records and monitors the participants progress toward goals within specific timeframes. Documents assessments and key patient updates in electronic medical records and care management system; documents relevant day-to-day activities and patient data.
• Prepares reports and documents as needed or requested.
• Assist patients in housing search acquiring documents for applications submitting applications and supporting patients with housing interviews.
• Serve as a connection for landlords and property management if patients housing is in jeopardy or for crisis intervention.
• Provide pre and post-tenancy supports to include development of budget connection to representative payee paying rent and utilities service planning obtaining furniture moving into housing and connection to community and in-home resources.
• Coordinate with other housing providers to ensure long-term supports are available for patients.
• Provide advocacy for patients with application denials and hearings conducted by housing providers.
• Provide eviction prevention support to include attending housing court submitting necessary documentation and making appropriate referrals to legal services.
• Provide intensive home and community-based outreach motivational interviewing and goal setting resource connection and accompaniment to medical appointments as needed to help patients appropriately utilize healthcare.
• HS may visit patients in hospital and ER settings to facilitate with transitions of care.
• Establishes culturally appropriate and trusting relationships with patients and their families.
• Participates in all training activities as designated by Nurse Manager and Administrative Manager.
• Attends regularly scheduled supervision and other program assigned meetings.
• Develops and maintains strong relationships with the community and community resources to ensure patient access.

NOTE: The HS will not provide hands on care or other services noted as home health services including but not limited to: performance assessments provision of care treatment or counseling; and/or monitoring of patients health status.

Must adhere to all of BMCs RESPECT behavioral standards.

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

JOB REQUIREMENTS

EDUCATION:

HS Diploma with community experiences or Bachelors degree

CERTIFICATES LICENSES REGISTRATIONS REQUIRED:

Drivers license

EXPERIENCE:

Minimum of 2 years prior healthcare public health or community-based experience in community setting.

KNOWLEDGE AND SKILLS:

• Basic knowledge of healthcare system.

• Outstanding interpersonal skills of foremost importance to interact with families and patients.

• Interest in community health and outreach.

• Exceptional organizational skills; ability to multi-task and work independently and as part of a team.

• Demonstrated oral and written English communication skills.

• Fluency in Haitian Creole or Spanish preferable.

• Understanding of how language culture and socioeconomic circumstances affect health.

• Desire to work with diverse multi-cultural and multi-lingual populations.

• Proficiency with Microsoft Office applications (i.e. MS Word Excel Access Outlook) and web browsers. Proficiency with data entry and data tracking.

Compensation Range:

This range offers an estimate based on the minimum job qualifications. However our approach to determining base pay is comprehensive and a broad range of factors is considered when making an offer. This includes education experience skills and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs internal equity and addition BMCHS offers generous total compensation that includes but is not limited to benefits (medical dental vision pharmacy) discretionary annual bonuses and merit increases Flexible Spending Accounts 403(b) savings matches paid time off career advancement opportunities and resources to support employee and family well-being.

NOTE: This range is based on Boston-area data and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans

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