Integrated Care Specialist - Shelter Based

Job Type


Full-time

Description

POSITION TITLE: Integrated Care Specialist - Shelter Based

REPORTS TO: Team Lead

FLSA CLASSIFICATION: Non-Exempt


POSITIONS SUPERVISED: None

POSITION OVERVIEW:


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.

ESSENTIAL FUNCTIONS

Service Delivery

• 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

Care Coordination & Collaboration

• 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

Monitoring Progress & Responding to Client Needs

• 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

Client Engagement & Support

• 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

Documentation & Compliance

• 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

ORGANIZATION STANDARDS:

Professionalism and Communication


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.

Time & Priority Management


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.

Reliability & Accountability & Ownership


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.

Adaptability and Change Agility


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.

Organizational Alignment and Mission Focus


Demonstrates behaviors aligned with the organization's mission, values, and professional standards while supporting goals and initiatives through actions and attitude. Consistently follows policies and ethical guidelines, maintains confidentiality, and contributes to a culture of professionalism, respect, and service.

POSITION REQUIREMENTS:

• Bachelor's degree in human services field OR equivalent experience required
• Experience with housing services, case management, or shelter-based services preferred
• Knowledge of community resources and benefits systems
• Experience working with individuals with mental health and/or substance use challenges
• Strong communication, organization, and problem-solving skills

Driver Level: Level 1, valid driver's license, reliable transportation, insurance and clean MVR required

Position Flexibility: This position is primarily community-based, with most work conducted in the field with clients. Required office-based tasks must be completed onsite; limited remote work flexibility may be available in accordance with HR approved department standards.

PHYSICAL REQUIREMENTS:

• Driving for community-based services
• Sitting for extended periods of time.
• Lifting/carrying up to thirty (30) pounds, climb, bending, stooping, balancing

All the above duties and responsibilities are considered essential job functions subject to reasonable accommodation. All job requirements listed indicate the minimum level of knowledge, skills and/or ability deemed necessary to perform the job proficiently. This job description is not to be construed as a detailed statement of duties, responsibilities or requirements. Employees may be required to perform any other job-related instructions as requested by their supervisors, subject to reasonable accommodation.

EEO race, color, religion, sex, parental status, national origin, age, disability, genetic information, political affiliation, military service, or other non-merit based factors.