Hospital Outreach Care Coordinator

About the Organization

At BRC, we help New Yorkers experiencing homelessness reclaim their lives with opportunities for health, self-sufficiency, and hope, while restoring dignity and respect. We invest in our employees through growth, learning, and meaningful work across Manhattan, Brooklyn, the Bronx, and Queens, offering a wide range of benefits and a supportive team environment.

About the Role

The Hospital and Care Coordination position is responsible for coordinating hospital discharge planning, facilitating client placements into Safe Haven and other housing settings, conducting field-based outreach, supporting medically vulnerable clients through healthcare navigation and follow-up care, and maintaining accurate documentation and grant reporting to ensure continuity of care and program compliance.

Responsibilities

• Hospital and Care Coordination
  • Coordinate discharge planning with hospital social workers, care managers, discharge planners, and medical teams.
  • Coordinate the movement of patients between a hospital or skilled nursing facility and Safe Haven programs and other appropriate housing or shelter settings.
  • Ensure a safe transfer to a setting that meets the patient's needs and coordinates necessary services and staff required to complete the transfer.
  • Conduct in-person hospital visits to meet with clients prior to discharge and support transition planning.
  • Collaborate closely with outreach teams to ensure continuity of care and engagement after discharge.
  • Assist clients in attending medical appointments, obtaining medications, securing medical equipment, and understanding discharge instructions.
  • Monitor and support follow-up care for medically complex and high-vulnerability clients.
  • Identify urgent medical, psychiatric, or social service concerns and escalate appropriately.
• Outreach and Client Engagement
  • Conduct field-based outreach throughout New York City, including street engagement and visits to hospitals, shelters, and Safe Haven sites.
  • Build rapport with individuals experiencing homelessness using trauma-informed and client-centered approaches.
  • Support clients with healthcare navigation, benefits access, transportation coordination, and appointment scheduling.
  • Maintain communication with multidisciplinary providers, including hospitals, behavioral health providers, outreach teams, and shelter staff.
• Administrative and Grant Management Duties
  • Maintain accurate and timely documentation of client interactions, referrals, placements, and outcomes.
  • Track grant deliverables, program metrics, and required reporting data.
  • Manage program-related email communication with hospitals, providers, and internal teams.
  • Assist with data collection, quality assurance, and reporting requirements related to grant funding.
  • Provide day-to-day administrative support, maintain organized records while ensuring compliance with confidentiality and HIPAA-related standards.
  • Support program leadership in identifying trends, service gaps, and opportunities for improved coordination.

Requirements

• Medical assistant certification, healthcare training, EMT experience, nursing support experience, or similar medical background required.
• Associate's or Bachelor's degree required, or demonstrated equivalent experience in lieu of a degree.
• Minimum of 1–2 years experience in homeless services, healthcare coordination, hospital discharge planning, outreach, case management, or related fields.
• Strong interpersonal, communication, and organizational skills.
• Ability to work independently and effectively in both office and field settings.
• Proficiency with Microsoft Office and electronic documentation systems.
• Ability to travel throughout New York City, including hospitals, shelters, Safe Haven programs, and other community locations.