Health Homes Care Coordinator

Job Overview

The Health Homes Program (HHP) provides comprehensive case management services for community members who are marginalized, have a history of chronic/mental health conditions, and are frequently hospitalized. The HHP usually works with clients for about year to ensure they are connected to all of the needed services. Service linkage may include physical and behavioral health services, substance use treatment, community-based long-term services, home visit services, and assessment for other supportive/long-term needs.  As a small team, the HHP works closely and collaboratively and we are dedicated to making a big impact for our most vulnerable populations!

The Health Homes Care Coordinator (HHCC) will be assigned a caseload of clients as they enroll into the program. The HHCC will be responsible for assessing the client's needs and strengths in order to create a client-centered care plan. The goal of each care plan is to help clients achieve their health, psychosocial and basic-need goals. The HHCC will  work collaboratively with the client's primary care provider and any other specialists/clinicians to support the client in reaching their goals.   Following safety protocols, the HHCC will meet the client where they feel most comfortable. This may include meeting in the client's home, single-room occupancy hotel, shelter, encampment, or at a location in the community.  This position provides a great opportunity to work as a part of a multidisciplinary team, provide one-on-one specialized case management, and learn about various community resources. This role is ideal for someone who is interested in building their skills as a case manager within the medical or social work field.

Key Responsibilities

  • Works with clients, their support systems, and the healthcare team to create and manage HHP care plan
  • Acts as a liaison between client, healthcare team, and any outside resources to help the client follow the care plan
  • Documents  all encounters/appointments/phone calls regarding HHP patients with strong attention to detail
  • Provides services where HHP clients live, seek care, or find the most easily accessible setting within safety guidelines 
  • Accompanies HHP patients to medical/social services appointments
  • Connects HHP clients to other social services and support the client may need
  • Advocates on behalf of members with health care and social services professionals
  • Works with hospital staff on discharge plans
  • Monitors treatment adherence and informs teams of any changes or lack of adherence
  • Able to stay multi task and meet requirements/deadlines while managing a caseload of several HHP clients 

Education and Knowledge, Skills and Abilities

Education and Experience: 

  • Bachelor's degree from accredited college/university  AND 1 year of experience working with under-served populations such as those in the criminal justice system and/or experiencing homelessness OR  2 years or more of experience working with under-served populations such as those in the criminal justice system and/or experiencing homelessness.
  • Experience with the following: trauma informed care, harm reduction, outreach, case management, fieldwork


  • Ability to provide culturally competent and non-judgmental services to the population we serve 
  • Ability to enter data into various electronic systems
  • Professional, punctual, flexibility and reliability imperative
  • Excellent verbal, written, and interpersonal skills
  • Integrity to handle sensitive information in a confidential manner
  • Action oriented and ability work on your own and as a team 
  • Ability to communicate well at all levels of the organization including working with organization leadership and high-level representatives of partner organizations 


  • Bilingual in a threshold language (salary differential)
  • Knowledge of co-occurring disorders and dual-diagnoses 
  • Knowledge of clinical documentation 
  • Knowledge of motivational interviewing
Compensation: $50,000.00-$52,000.00
Type: Hourly/ Non-exempt
Benefits: HealthRIGHT 360 offers a competitive benefits package.
City: San Francisco, CA
Hours/wk: 40

Job Location