Coordinated Entry / Reentry Care Coordinator

JOB DESCRIPTION

PROGRAM: Housing & Community Services

TITLE: Coordinated Entry / Reentry Care Coordinator – Lewis County

JOB CLASSIFICATION: Care Coordination Specialist

HOURLY RANGE: $25.24-$27.60

DEPARTMENT: Housing & Community Services

IMMEDIATE SUPERVISOR: Housing Program Manager – Housing & Community Services

SUMMARY DESCRIPTION

This position provides comprehensive care coordination and Coordinated Entry (CE) services for individuals experiencing substance use disorder, frequent and lengthy terms of incarceration, homelessness, or housing instability. The Care Coordinator works with participants to develop individualized support plans to achieve housing stability and move toward self-sufficiency.

This position is part of the Lewis County Coordinated Entry system and conducts CE eligibility screenings, diversion conversations, and full CE assessments with individuals experiencing homelessness or housing instability, including individuals currently incarcerated in the Lewis County Jail who are preparing to reenter the community.

The Care Coordinator interacts with diverse community supports including behavioral health, substance use treatment, physical health providers, criminal justice partners, benefits systems, and employment services. The position operates under a braided service model combining Coordinated Entry activities with care coordination funded through Foundational Community Supports (FCS) and the Pathways Community HUB.

This is a full-time position based in Lewis County, WA. The position includes regular work within the Lewis County Jail and frequent travel throughout the county to conduct field visits, home visits, and community coordination.

FUNCTIONAL RESPONSIBILITIES

• Coordinate care that is safe, timely, effective, efficient, equitable, and client-centered.
• Conduct Coordinated Entry eligibility screenings, diversion conversations, and full CE assessments.
• Enter Coordinated Entry assessments and updates into HMIS and maintain accurate referral documentation.
• Accept case assignments promptly, review case progress, and determine appropriate program exits.
• Help clients achieve wellness, housing stability, and autonomy.
• Complete comprehensive assessments including goals, steps to achieve goals, and resources needed to achieve self-sufficiency.
• Maintain regular communication with tenants, landlords, community partners, funders, and management.
• Educate and inform applicants of program requirements and responsibilities.
• Provide skills training in household budgeting and housing stabilization.
• Advocate and refer for services including financial assistance, legal aid, housing, job placement, education, primary healthcare, mental health services, substance use disorder treatment, and other client-identified needs.
• Coach participants to improve self-advocacy and independent living skills.
• Complete all required documentation including progress notes, eligibility verification, enrollment records, service tracking, and participant contacts.
• Collect data and prepare reports as required by program procedures and agency policies.
• Attend scheduled interdisciplinary team meetings and supervisory sessions.
• Complete all required training for the Care Coordinator position and actively participate in professional development planning.
• Positively represent CCAP in the community, including external meetings and collaborative forums.
• Positively contribute to healthy, collaborative department and agency cultures.
• Collaboration with Correctional Facilities: Maintain excellent communication with correctional facility staff, including medical teams, case managers, and other relevant personnel within the correction system, for care coordination and data tracking.
• Regularly visit jails and prisons, including Lewis County Jail, to provide support, conduct assessments, and follow up on care plans for Adults in custody.
• Engage in regular communication via phone and video streams with Adults in custody to collaborate on goals and develop comprehensive reentry plans.

JAIL-BASED COORDINATED ENTRY SERVICES

Each Care Coordinator provides Coordinated Entry services within the Lewis County Jail one day each week.

This dedicated jail day includes:

• Six hours of Coordinated Entry activities, including eligibility screening, diversion conversations, and full CE assessments with incarcerated individuals who may be experiencing homelessness or housing instability upon release.
• Two hours of documentation, including HMIS data entry, CE assessment updates, and referral documentation.

The goal of jail-based CE services is to ensure individuals who are preparing to exit incarceration are connected to housing resources and service systems prior to release.

During the remainder of the work week, Care Coordinators may also conduct follow-up visits within the jail as needed while providing ongoing care coordination services throughout the community.

CARE COORDINATION RESPONSIBILITIES

In addition to CE activities, Care Coordinators provide ongoing housing-focused care coordination including:

• Field visits and home visits with participants
• Coordination with housing providers and landlords
• Assistance obtaining identification, benefits, and documentation
• Connection to behavioral health and substance use treatment providers
• Housing search assistance and housing readiness planning
• Coordination of services through Foundational Community Supports and Pathways HUB programs
• Support for individuals transitioning from incarceration into stable housing

• Provide transportation when necessary to support successful reentry and housing stability, including picking participants up from the Lewis County Jail upon release and transporting them to housing placements, treatment providers, appointments, or other essential destinations.

• Assist participants in connecting to services based on their individual goals and preferences, including behavioral health, substance use treatment, medical care, employment services, housing programs, and other community resources.

• When participants choose to engage with other organizations that provide similar or ongoing support services, facilitate connection through scheduling, transportation, and introductions, and transition support to the receiving provider when appropriate.

MINIMUM QUALIFICATIONS

• Certified Peer Counselor. Lived experience of incarceration with demonstrated success in self-advocacy.
• Ability to pass and maintain a background check.
• Knowledge of the criminal justice system continuum of care.
• Experience working with and supporting individuals with a history of incarceration, recidivism, and substance use.
• Familiarity with self-help groups and 12-step programs.
• Current Washington State Driver’s License and auto insurance for frequent travel throughout the county to meet participants. Clean driving record required.

PREFERRED QUALIFICATIONS

1. Lived experience with homelessness and factors associated with housing instability.

2. Bilingual- English/ Spanish

3. Certified Peer Counselor training

4. Proficiency in Microsoft word

5. Motivational interviewing skills

6. Excellent oral communication skills.

7. Organizational and time management skills.

8. Problem-solving skills

9. Other cultural competencies that contribute to the agency’s effectiveness in serving diverse populations.

10. AA/BA/BS degree in related human services field.

LOCATION / WORKING HOURS

This is a full-time position based in Lewis County, Washington. Program hours of operation are 8:00 AM – 5:00 PM Monday through Friday, though schedules may occasionally vary depending on program needs.

This position includes regular work within the Lewis County Jail as well as frequent travel throughout the county to conduct field visits, home visits, and coordination with community partners.

This position is subject to pre-employment drug testing.

Pay: $25.24 - $27.60 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

People with a criminal record are encouraged to apply

Work Location: In person

Salary : $25 - $28