Care Coordinator - RISE Program

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.

Union:
Yes

Union Name: 1199

SEIU

Patient Facing:
Yes

The Care Coordinator will be an integral part of a multidisciplinary team within our RISE (Reentry Initiatives for Support and Empowerment) program working with homeless, incarcerated individuals in Suffolk County. BHCHP has partnered with the Suffolk County Sheriff’s Department (SCSD) at two county jails to outreach to this population. This program aims to engage this population prior to release, to connect with external Medication for Opioid Use Disorder (MOUD) partners to improve transitions of care for these individuals upon release, and ultimately to improve outcomes related to drug use in this population who are at a particularly high-risk of fatal overdose upon release.

The Care Coordinator will join an interdisciplinary team of doctors, nurses, a clinic/project director, therapist, care coordinators, recovery coach and others working together to support incarcerated individuals with a diagnosis of opioid use disorder, those at high risk of fatal overdose prior to release, and those with chronic health conditions on the day of release, and in the post-release period to provide the following:

• Pre-release support including Critical Time Intervention, case management, behavioral health services, psychiatry, recovery support groups, legal case management, MOUD evaluations, HIV and HCV screening and referrals, and referrals to recovery coaching. Services are provided directly in-person at the jail when permitted, or by telehealth encounters.
• Support on day of release from jail including in person visits to the jail or courthouse, transportation support, care coordination, accompanying individuals to medical appointments and to obtain prescriptions, naloxone provision and naloxone training for overdose reversal.
• Post-release support including a continuation of pre-release supports, as well as support with direct MOUD provision, psychiatric treatment/medication bridging, individual therapy, and Hepatitis C (HCV) treatment.

BHCHP utilizes a community-based overdose prevention model to recovery and the care coordinator will be working with individuals at all stages of recovery, including people who are actively using drugs. 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.

Applicants proficient in both English and Spanish are encouraged to apply.

This position is funded until the end of February 2027 with the possibility for renewal. If this funding is not renewed, this position will end February 28th, 2027.

• Meet with patients in jails to assess patients’ financial, housing, legal, addiction treatment, and other social service…