SUMMARY OF POSITION: As part of the H2H multidisciplinary team will be working in both hospital and community setting to engage homeless and/or housing insecure patients to identify and secure services for their physical, behavioral, and basic needs outside of emergency medical services. Responsibilities: • Work directly with the hospital social worker to engage, accept and process referrals to the program • Conduct comprehensive, ongoing assessments of clients’ mental health, physical health, housing status, other basic needs, and barriers that impact optimal wellbeing in the community. • Manage primary case load of > 50 by completing treatment plans and coordinating care through monthly client schedules • Facilitate person centered, strengths base case management services to individual clients in the office, hospital and in community settings. • Refer and assist in warm handoffs to appropriate community agencies, consistent with evolving service planning. • Coordinate and provide assistance to clients with making and keeping appointments and any other tasks within medically necessity of client’s recovery process • Act as advocate and liaison, consulting with community agencies and providers to maintain coordination of care and transition. • Collaborate with other members of the H2H team during daily and weekly staff meetings • Facilitate stage-wise interventions with an emphasis on personal growth and development towards recovery and wellness • Coordinate with outside inpatient services to provide needed services to clients and establish linkages with treatment groups and other support networks • Side by side assistance in obtaining federal and state social services (ie. social security, food stamps, Medicaid, etc.) • Maintain St. Patrick Center client tracking system and client files (ie. assessment, service plans, ect.), documenting client contact and progress; to maintain a permanent record of client activity within the timeframe required (24 hours) • Be responsible for agency policy regarding work hours, building security, and all written personnel standards • Work at both SLU/SSM and St. Patrick Center • Perform within the St Patrick Center’s adopted care models: Housing First and Trauma Informed Services. Direct Reports: None Knowledge & Experience • Bachelor degree in social work, counseling or a related field from an accredited university. Preferred Master degree in social work, counseling or related field. • Understanding of mental illness and substance use • Understanding of strengths base case management/wrap-around services • Knowledge and understanding of community agencies • Be able to work in a high pace organization • Housing First Model • Trauma Informed Care • Knowledge of federal, state, and agency HIPAA policies • Must possess current Class E Driver’s license (Missouri residents only) Skills and Attitudes • Excellent verbal and written communication skills • Crisis intervention expertise • Self-motivation due to the autonomous nature of the position • Respect for clients and staff • Sensitivity to cultural diversity • Ability to work in a team atmosphere • Moderate computer skills Relationships Required • Report to and work with Hospital to Housing Manager and SSM/SLU Supervisor • Attend and participate in all appropriate St. Patrick Center and SSM/SLU meetings Resources • Mileage reimbursement • Off site trainings • Partner agencies (networking opportunities)