Organizational Description & Position Overview:
Catholic Charities of West Tennessee’s Homeless Services division is hiring a full-time Healthcare Navigator/ Case Manager to serve in our Veteran-specific Rapid Rehousing and Prevention programming. This position is federally-funded by the Department of Veteran Affairs (VA) for the Supportive Services for Veteran Families (SSVF) grant. The SSVF Case Manager will engage and build rapport with individuals and households who are identified as homeless veterans as defined by the guidelines and regulations enforced by U.S. Department of Housing and Urban Development (HUD) in conjunction with the Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009 (Hearth Act) and the VA. This position will assist the most vulnerable clients in breaking the cycle of homelessness by connecting veterans to permanent housing and local resources, including veteran benefits and services, mental health and substance abuse partners, accessing mainstream benefits, and partnering service providers. This position will also receive internal, health care navigation referrals to ensure clinical coordination of care between the Veteran Affairs Medical Center and the Veteran households in need. The SSVF Health Care Navigator/Case Manager works closely with the Veteran’s assigned multidisciplinary team, including medical, administrative specialists, and case management personnel, to provide timely, appropriate, Veteran centered care equitably and identify and address systems challenges for enhanced care coordination as needed.
SSVF Healthcare Navigator/Case Manager will provide case management and care coordination, health education, interdisciplinary collaboration, coordination, and consultation, and administrative duties. SSVF Healthcare Navigator/Case Manager works closely with the Veteran’s primary care provider and members of the Veteran’s assigned interdisciplinary treatment team. Populations served include Veterans and their families experiencing homelessness or imminent risk of homelessness. Sensitivity to needs concerning age, developmental requirements, culturally related factors, mental health, and substance use all must be consistently achieved during the facilitation of care. In addition to healthcare navigation services, SSVF Healthcare Navigator/Case manager will identify and engage with homeless, or at imminent risk of homelessness, veteran individuals and families, to assist them in obtaining and retaining permanent affordable housing. This will require establishing effective case management relationships with at-risk and homeless veteran families, building relationships with property managers and other social service providers in coordination with the SSVF Program. The SSVF Healthcare Navigator/Case Manager will provide guidance and navigation through leasing, housing case plans, financial planning, client-focused goals, employment assistance, and other supportive services necessary to sustain permanent housing and community integration. Catholic Charities of West Tennessee and its Housing Ministry participate in the Memphis and Shelby County Homeless Consortium, and TN-501 Continuum of Care. This position will work within an assigned case load of clients using a person-centered approach, in a multi-agency environment, while practicing Harm Reduction, Trauma-Informed Care, and Motivational Interviewing. Sensitivity to needs concerning age, developmental requirements, culturally related factors, mental health, and substance use all must be consistently achieved during the facilitation of care.
Duties/ Responsibilities include, but are not limited to the following:
- Maintains a multi-faceted caseload of veterans and families; working with clients to meet their goals related to housing, financial stability, vocational/employment, transportation, and family needs.
- Knowledgeable of the Memphis and Shelby County Homeless Consortium and Coordinated Entry System, including homeless assistance regulations, Housing First, SSVF specific regulations, Veteran Affairs and the Veteran Affairs Medical Center, VASH, and other partnering service providers within the Continuum of Care.
- Works directly with veteran clients in identifying barriers to self-sufficiency and develops goals and objectives for overcoming these barriers through developing a housing stability plan.
- Navigates the leasing and housing process per client, assisting clients in locating appropriate housing, inspecting the unit, signing the lease and facilitating any moving needs that come along with the process.
- Enters data precisely and accurately, tracking relevant data on a timely basis in the Homeless Management Information Systems Database, maintaining complete and organized client files.
- Projects spending based on needs and housing per client, working with program coordinator on financial accuracy and availability.
- Processes and submits temporary financial assistance and services accurately via HMIS and internal accounting forms, with supportive documentation in conjunction with the projected budget.
- Promotes self-sufficiency with all clients; explains the nature of the available programs, procedures and services.
- Coordinates and initiates monthly home visits (at minimum) with each client, offering flexible services and more intensive case management when necessary, with the potential for increased services as client needs change and evolve throughout their rental assistance process.
- Explains the benefits, advantages and encourages veteran and military families to participate in case management and supportive services offered throughout the community.
- Identifies strengths and needs and makes referrals to available VA and community resources to meet those needs. Client files will track individual needs, assessments and strategies.
- Coordinates with Catholic Charities staff, VA Staff and any other service providers working to meet the needs of veteran and military families, mediating and facilitating communication between veteran and these resources
- Attends and participates in community-wide meetings and trainings as needed.
- Links to community resources for integration purposes, socialization, recreation, education, occupation and vocational needs of veteran served.
- Remains familiar with current Veteran Administration regulations as they relate to needs of the client base, in addition to HUD regulations and SSVF program mandates.
- Coordinating client employment needs with the Employment Support Specialist onsite.
- Provides crisis intervention when needed as well as connection to mental health services.
- Responds to inquiries, phone calls, and e-mail in a timely and responsive manner.
- Completes mandated forms, HMIS case notes, service plans, exit plans, and financial assistance being provided, ensuring all are done in a timely manner and error free.
- Provides transportation to individuals according to the needs identified in plans.
- Builds and fosters relationships with a network of community providers of a variety of services and resources, including local shelters, mental health providers, and other housing services programs.
- Other duties as assigned.
- Administers non-clinical assessments to determine Veteran’s situation, barriers to care, the causes, and the impact of such barriers on the ability to access and maintain health care services.
Health Care Team and Veteran Communication
- Assists Veterans in communicating their preferences in care and health-related goals to facilitate shared decision making, while serving as a resource for education and support to Veteran families.
Specialized Case Management and Care Coordination
- Provides comprehensive case management and care coordination across episodes of care.
- Serves as the subject matter expert on community resources related to the Veteran. Collaborates with providers on reassessment.
- Determines any limitations of each Veteran while engaging in problem-solving health care barriers and accessibility.
- Assists households by providing educational support, health literacy, and promotion of self-care.
Interdisciplinary Collaboration, Coordination and Consultation
- Collaborates with other disciplines involved in providing care, consulting with other team members and reassessing the needs of the Veteran, while adhering to ethical principles about confidentiality, informed consent, compliance with relevant laws, and agency policies (HIPPA, incident reporting, Duty to Warn, etc.).
Administrative Duties and Systems Improvement
- Identifies systemic barriers, develops procedures and practice guidelines, and builds relationships with local providers and health care systems to effectively ensure connection to support is maximized.
Qualifications, Experience and Abilities
- Master’s Degree in Social Work, LCSW, LMSW preferred. Three-Five years of related experience.
- Training and experience in Harm Reduction, Trauma-Informed Care and Motivational Interviewing preferred, with the ability to quickly respond and de-escalate if warranted.
- Experience with psychiatric/mental health services and other community programs.
- Excellent written and verbal skills in the English language.
- Excellent computer skills, with experience in the Homeless Management Information Systems Database (HMIS) preferred.
- Excellent interpersonal and communication skills.
- Ability to act in accordance with varying and changing consumer needs, some unpredictable.
- Demonstrates cultural sensitivity and perspective, as well as respect for the client’s individualized and client-focused care.
- Ability to establish and maintain professional boundaries in working with clients.
- Demonstrates a positive attitude, self-motivation, organization, and resourcefulness while maintaining a team and client focus, willing to assist where/when needed.
- Knowledge of local resources and services, social and environmental determinants of health, health promotion, disease prevention, curative, rehabilitative, and supportive services.
- Ability to work independently.
- Ability to manage multiple projects with demanding and competing deadlines, superior organizational skills and the ability to maintain a quality work place in a diverse, fast paced, stressful and changing environment.
- Demonstrates professional development by participating in and seeking training opportunities.
- Ability to negotiate different work personalities and work under competing priorities.
- Ability to lift 25 lbs.
- Requires a valid unrestricted driver’s license with acceptable driving record.
- Driving Status Primary (25% or more).
- Must be able to pass a background check.
Disclaimer: This is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts or working conditions associated with the job. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job description or to require that other or different tasks be performed when circumstances change (e.g., emergencies, changes in personnel, workload, etc.)
***Grant funded positions and salaries are dependent on funding availability. Position can be eliminated at any time because of lack of funding to support this position.***