About this role
Who We Are:
Since 1985, BHCHP’s mission has been to ensure unconditionally equitable and dignified access to the highest quality health care for all individuals and families experiencing homelessness in greater Boston. Over 10,000 homeless individuals are cared for by Boston Health Care for the Homeless Program each year. We are committed to ensuring that every one of these individuals has access to comprehensive health care, from preventative dental care to cancer treatment. Our clinicians, case managers, and behavioral health professionals work in more than 30 locations to serve some of our community’s most vulnerable—and most resilient—citizens.
From our earliest days as a program, we have always sought to do work that is transformational: recognizing our shared humanity; centering dignity, compassion, mutual respect and supporting the right of every individual to access the highest levels of health care and every staff member to reach their fullest potential. We continue to be committed to building bridges and breaking down barriers, including systemic racism which harms us all. We provide community-based health care services that are compassionate, dignified, and culturally appropriate, incorporating social determinants of health, with the goal of breaking down the physical and systemic barriers that our patients face.
Job Summary:
Hours: Full-time, 40 hours per week, Monday-Friday, 8:30 AM-5:00PM
Union: None
Union Name: None
Patient Facing: Yes
The Manager of Reentry Services plays an integral part of a multidisciplinary team working within our BMC clinic to support homeless, incarcerated individuals in Suffolk County in their release and will directly oversee the outreach, enrollment, and ongoing case management for individuals in the six months surrounding their release. BHCHP has partnered with the Suffolk County Sheriff’s Department (SCSD) at two county jails to outreach to this population.
The Manager of Reentry Services is part of BHCHP’s Reentry Initiatives for Support and Empowerment (RISE), an interdisciplinary team of doctors, nurses, a clinic/project director, therapist, care coordinators and others working together to support incarcerated individuals prior to release, on the day of release, and in the post-release period.
More specifically, this role will supervise a group of care coordinators and will help support individuals at all stages of recovery and supporting the care coordinators to do the same. This position offers a tremendous opportunity to work at the intersections of the opioid epidemic, incarceration, and homelessness, to address the root causes of illness in a collaborative team-based community health center context.
This position is funded until the end of September 2031 with the possibility for renewal. If this funding is not renewed, this position will end September 30, 2031 .
Responsibilities:
- Supervise the reentry care coordinators and support them in their work to assess patients’ financial, housing, legal, addiction treatment, and other social service needs in the pre-release period and develop comprehensive patient centered care coordination plans to address these needs and provide support and follow up in the post-release period; provide timely and insightful feedback to care coordinators to help them problem solve the unique set of factors associated with each patient’s release; provide reentry care coordination as needed for a small pool of patients, while balancing supervision and reentry case management responsibilities.
- Manage BHCHP’s RISE team panel of patients including assigning care coordinators and managing their caseloads. Oversee the development and implementation of comprehensive referral and transition plans for RISE team patients in the 2-4 months post release.
- Support care coordinators to successfully and effectively transition patients to a long-term care team within 6 months of enrollment.
- Oversee care coordinators’ patient referrals to RISE team services including psychiatry, MOUD, legal case management, recovery coaching, and behavioral health.
- Serve as the point of contact for any reentry case management questions or needs as they arise across BHCHP. Set up communication for BHCHP patients from other teams to maintain contact and expedite care coordination upon release. Facilitate BHCHP staff across the program to do in-person jail visits as necessary; in conjunction with BHCHP’s Americorps Program Manager, select, onboard, train and supervise the RISE team Americorps position each year.
- Attend QEC on behalf of the RISE team as needed; utilize BHCHP’s population health management tools such as Azara and Epic to understand which patients are in need of additional health screenings and follow up, monitor quality metrics; identify consistent or unique reentry case management issues and/or barriers to care for incarcerated patients and problem solve with the clinic project director, BMC clinic leadership, and SCSD leadership; ensure reentry care coordinators are complying with documentation protocols and best practices; document all encounters with patients in BHCHP’s electronic medical record (EMR), maintain accurate and up-to-date (non-clinical) records and standardized data on all patients.
- Communicate regularly with BHCHP RISE team members regarding the status and needs of the patients releasing from SCSD using a variety of HIPAA compliant communication mechanisms including email, TigerText, phone, and BHCHP’s EMR; support the project director in ensuring the team complies with the reporting and evaluation requirements set forth by the federal, state, and local agencies that fund the RISE team services, collaborate with both internal and evaluation partners as needed; along with the project director, order supplies for RISE team as needed.
- Co-facilitate groups focused on care coordination, overdose prevention, and recovery-related topics for individuals while they are incarcerated at both NSJ and SBHOC. Attend SCSD bimonthly programming meetings, bimonthly orientation meetings, and other SCSD meetings as needed; systematically review the RISE team panel of patients each week with the care coordinators and project director, focusing on new patients and patients who are having difficulties, and upcoming releases; lead the RISE team weekly huddle to cover these topics.
- Serve as the BHCHP contact for ATR and supervise the management of the ATR referral process
- Advance BHCHP’s ability to document, bill for, and maintain compliance with new and existing reentry case management programming in a standardized way across multiple payors (e.g., for MassHealth’s Community Support Program for Justice Involved (CSP-JI) and other programs and funding sources). This includes working across multiple departments and sites to develop and implement policies and procedures that align with regulatory and contractual requirements for these programs, while ensuring staff possess the guidance and tools required to execute the programs with fidelity.
- Invite outside community agencies to lead trainings or talks for BHCHP staff on reentry health care needs. Update the CM Wiki and BHCHP Wiki pages to keep BHCHP staff alert for incarceration related resources; maintain and update lists of contacts of SCSD staff and other community agencies that regularly do reentry work. This includes records for Medical Records contacts of different sheriff’s departments in the state.
Qualifications:
- Supervision experience, specifically supervision of case management staff preferred.
- Knowledge of healthy and appropriate boundaries when working with vulnerable populations; Demonstrated interest and experience in working with vulnerable populations, including those with active substance use disorder, histories of incarceration, and/or homelessness; comfort with multiple pathways to recovery from SUD and willingness to embrace a patient-centered approach that recognizes an individual’s preferences and autonomy.
- An understanding of the criminal justice system and the barriers it can present within the health care context; comfort in working in medical, criminal justice, and social service settings.
- Knowledge and understanding of reentry case management needs and how they differ from the general population of patients receiving services at BHCHP, knowledge and understanding of the addiction treatment framework and strategies for opioid overdose prevention and response, or willingness to be trained to become expert in these topics.
- Comfort with multiple pathways to recovery from SUD and willingness to embrace a patient-centered approach that recognizes an individual’s preferences and autonomy, comfort in working in medical, criminal justice, and social service settings.
- Computer proficiency, effective use of the Internet and Microsoft Office programs such as Word and Outlook, Microsoft Excel, PowerPoint, and familiarity with RedCap.
- Ability to work independently as well as part of a multidisciplinary team, ability to provide and receive accurate feedback without judgment or discomfort; excels at problem solving and multi-tasking and is organized, efficient and goal-directed.
- Ability to handle confidential information; flexibility to adapt to unforeseen needs or circumstances; strong advocacy skills along with knowledge of community-based services, resources, and local recovery community.
- Commitment to fair and culturally appropriate care for a wide range of populations, including (but not limited to) communities of color, LGBTQ communities, non-English speaking populations, people with histories of incarceration, people with substance use disorders and behavioral health challenges, and people experiencing homelessness.
Compensation and Benefits:
- The compensation ranges from $60,000 - $96,000 annually and increases based on years of experience.
- BHCHP full-time employees are eligible for our competitive time off program, health, dental and vision insurance, 403B retirement savings plan, pre-tax MBTA pass program with 40% discount, additional compensation for demonstrated bilingual proficiency and more. Benefits are prorated for part-time employees.
Does this amazing opportunity interest you? Then we'd love to hear from you.
As an equal opportunity employer, Boston Health Care for the Homeless Program is committed to providing employment opportunities to all qualified individuals and does not discriminate on the basis of race, color, ethnicity, religion, sex, gender, gender identity and expression, sexual orientation, national origin, disability, age, marital status, veteran status, pregnancy, parental status, genetic information or characteristics, or any other basis prohibited by applicable law.
Covid-19 Vaccination: Proof of Covid-19 vaccination(s) is optional for employment. Candidates who are offered employment will be given details about how to demonstrate receipt of vaccination if they choose to.
Please Note: Employment at Boston Health Care for the Homeless is at-will. Boston Health Care for the Homeless does not sponsor work authorization visas.