COPE Health Solutions Careers

Description

The Street Outreach Specialist provides street-based outreach and engagement services to clients experiencing unsheltered homelessness who are eligible for or enrolled in the CalAIM Enhanced Care Management and Community Support Program.  This person is often the first point of contact with clients, meeting people where they are in encampments, parks, transit corridors, vehicles, and other places not meant for human habitation. The Street Outreach Specialist builds strong relationships with clients to engage them in services, connect them to medical and behavioral health care, and move them toward interim and permanent housing.  Street Outreach Specialists are committed to removing the client’s barriers to care and housing by identifying critical resources for clients, helping them navigate through health care and housing services and systems, and promoting client health using Housing First, harm reduction, and trauma-informed approaches. They work closely with the Care Team, which may include doctors, nurses, and other clinical staff, as well as street medicine teams, behavioral health providers, and housing partners, to support positive client health outcomes and housing stability.

 

Position Description:

• Conduct proactive street-based outreach in encampments, parks, transit corridors, vehicles, and other places not meant for human habitation to engage clients in our care management program. 
• Establishes close relationships with and serves as a point of contact for clients, building trust through consistent, person-centered engagement over repeated contacts. 
• Screen clients for Medi-Cal enrollment and CalAIM Enhanced Care Management and Community Supports eligibility, and complete referrals and warm handoffs to the Care Team. 
• Complete Coordinated Entry System (CES) assessments using the Los Angeles Housing Assessment Tool (LA HAT) after completing required training, and support clients through the CES matching process. 
• Communicate with Care Team members (Patient Care Navigators, Community Health Worker, Primary Care Physicians and other health care providers) to facilitate client care. 
• Distribute water, food, hygiene kits, harm reduction supplies, and other basic needs items, and provide naloxone education as appropriate. 
• Identify resources for clients to overcome barriers to care, such as transportation, shelter and interim housing, replacement of identification documents (ID, birth certificate, Social Security card), and benefits enrollment (Medi-Cal, CalFresh, General Relief, SSI). 
• Support client transitions from the street to interim housing, recuperative care, sobering centers, or permanent housing, coordinating with Housing Transition Navigation Services and other Community Supports providers. 
• Provide crisis intervention, de-escalation, and safety planning, and connect clients to emergency, psychiatric, or substance use services when needed. 
• Coordinate with street medicine teams, County behavioral health outreach, CES partners, and other outreach providers to align efforts and conduct joint outreach as appropriate. 
• Respond to outreach referrals within program timeframes and follow up with the referral source. 
• Remain aware of current services offered by service providers, such as mental health, substance use treatment, shelter, housing, and employment assistance. 
• Maintain strict confidentiality in accordance with agency policies. 
• May accompany clients to medical, benefits, and housing appointments, and review and update the care plan with the Care Coordinator 

Position Expectations:

• Meet with Care Team (including, but not limited to, Patient Care Navigator, Community Health Worker and primary care provider; including Behavioral Health & Substance Use team members as appropriate) to discuss client care issues and needs and facilitate client health care. 
• Maintain documentation of all client encounters, including entry into HMIS and the organization’s care management platform, and complete reporting requirements according to organization standards 
• Track client information, schedules, files, and forms in a confidential manner. 
• Track client contacts, referrals, and attendance at medical, benefits, and housing appointments and initiate outreach and missed appointment procedures, as necessary, including locating and re-engaging clients who have moved or lost contact. 
• Attend and represent the organization at professional conferences, in-service trainings, and meetings at the request of or with the approval of supervisor. 
• Interest in working with underserved, unsheltered homeless populations, including people living with serious mental illness and substance use disorders. 
• Physical demands associated with field-based outreach, including walking long distances, standing for extended periods, carrying outreach supplies, and working outdoors in varying weather conditions. 
• Up to 80% local travel; daily driving to outreach sites throughout the service area. 
• Early morning, evening, and occasional weekend outreach shifts may be required. 
• Follow field safety protocols, including conducting outreach in pairs or teams and maintaining situational awareness. 

Qualifications:

• Minimum high school degree, some college education in social work, human services, public health, or a related field preferred. 
• Minimum two (2) years of experience in street outreach, homeless services, behavioral health, or case management; three (3) or more years preferred. 
• Working knowledge of Housing First, harm reduction, trauma-informed care, and motivational interviewing. 
• Familiarity with the Los Angeles Coordinated Entry System, HMIS, and CalAIM Enhanced Care Management and Community Supports preferred. 
• Strong understanding of cultural competency with the target population 
• Bilingual (English/Spanish) preferred. 
• Computer literacy desirable, including comfort documenting on a mobile device in the field. 
• Commitment to the mission of care coordination 
• Passionate, trustworthy, and empathetic when working with clients. 
• Ability to build relationships with different types of people, including clients who may be hesitant to engage, organization members, and health care providers. 
• Good communication and interpersonal skills and ability to speak concisely to clients and Care Team members. 
• Ability to remain calm and use sound judgment in unpredictable environments, with skills in crisis de-escalation. 
• Organized with confidential client material and appointment tracking. 
• Flexible and adaptable in response to changing client and health care providers’ needs. 
• Lived experience with homelessness, mental health, or substance use recovery is valued. 
• Valid California driver’s license, reliable transportation, and proof of auto insurance.
• CPR/First Aid and naloxone administration training, or willingness to obtain after

Benefits:
As a firm passionate about health care, we’re deeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities, and a paid parental leave program. You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/

About Enhanced Care Management
Enhanced Care Management (ECM) supports eligible Medi-Cal members with complex medical, behavioral and health-related social needs through comprehensive, person-centered coordination. Working across health care and community settings, multidisciplinary care teams—including care managers and community health workers—engage members, develop individualized care plans, connect individuals to appropriate services and coordinate with providers and community partners. The program seeks to improve access, continuity and health outcomes while addressing barriers that contribute to avoidable utilization.

About COPE Health Solutions
COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers, health plans and self-insured employers. For more information, visit https://copehealthsolutions.com/about-us/

To Apply:
To apply for this position or for more information about COPE Health Solutions, visit us at https://copehealthsolutions.com/careers/open-positions/