Integrated Care Specialist - Shelter

Description

POSITION TITLE: Integrated Care Specialist – Shelter Based

REPORTS TO: Team Lead

FLSA CLASSIFICATION: Non‑Exempt

POSITIONS SUPERVISED: None

The Integrated Care Specialist – Shelter Based provides case management and integrated care services within a shelter‑based environment, supporting residents in achieving stability, improving functioning, and securing permanent housing. This role utilizes a Housing First, trauma‑informed, and harm reduction approach to deliver person‑centered services, coordinate care, and support residents in reaching individualized housing, health, and wellness goals.

• Provide direct case management services to residents in a shelter‑based environment, supporting progress toward housing stability, recovery, and independence
• Develop and maintain individualized service/treatment plans, including goal setting, strengths assessment, and ongoing updates
• Coach and support residents in developing independent living and ADL skills, medication management and self‑care, budgeting and financial stability
• Assist in securing and maintaining housing, including housing searches and landlord engagement
• Support access to benefits and resources (e.g., SSI/SSDI, food assistance, healthcare); transport residents as needed using a personal vehicle

• Coordinate services across internal teams, providers, and partners to support continuity of care
• Advocate on behalf of residents to ensure access to needed services and resources
• Communicate with treatment team members, stakeholders, and community agencies
• Participate in team meetings, case reviews, and communication to align service delivery

• Monitor resident progress, engagement, and stability within the shelter‑based environment
• Identify changes in needs, risks, or barriers to housing and adjust service accordingly
• Provide crisis intervention, conflict resolution, and support for behavioral health needs
• Develop and support crisis planning (e.g., WRAP plans) and respond to urgent situations

• Build strong, professional relationships using a person‑centered, trauma‑informed approach
• Engage residents in services that promote dignity, choice, and empowerment
• Encourage participation in goal planning, services, and community integration
• Promote a welcoming, respectful shelter‑based environment that enhances the overall experience

• Complete accurate, timely documentation, including service notes, treatment plans, and required reports, ensuring agency, regulatory, and contract standards, and productivity expectations
• Maintain communication logs and required records to support continuity of care
• Complete required trainings and adhere to all policies, procedures, and safety standards
• Other duties as assigned

Demonstrates clear, respectful, and professional communication in both verbal and written interactions, with a focus on collaboration and solution‑oriented dialogue. Shares information responsibly and addresses concerns constructively while maintaining a positive, professional demeanor—even in challenging situations.

Effectively manages workload by prioritizing tasks, planning proactively, and addressing challenges to meet deadlines and responsibilities. Maintains a solution‑focused approach and professional composure while balancing competing priorities.

Demonstrates dependability by consistently meeting commitments, deadlines, and responsibilities while taking ownership of work and outcomes. Acts with integrity, follows through on obligations, and addresses mistakes proactively to support a culture of accountability and trust.

Demonstrates adaptability by embracing new processes, priorities, and organizational changes with resilience and a willingness to learn. Adjusts work approaches as needed and supports others through change with a constructive, solution‑focused mindset.

Demonstrates…