Director of Housing Clinical Support Services

Job Description

Housing for Health (HFH) at NYC Health + Hospitals (H+H) recognizes that the chronic health issues of unhoused individuals cannot be treated without stable housing. This initiative seeks to improve the health and wellbeing of New Yorkers by focusing on four strategic areas: housing navigation services, medical respite beds, affordable housing on hospital property, and social service support for patients in permanent housing.

HFH is seeking a Director of Housing Clinical Services to serve in a clinical leadership role, managing clinical operations, integration and strategy across all aspects of HFH programming. This position will collaborate and partner with a diverse range of stakeholders within and beyond our large public hospital system, combining patient-level clinical triage, assessment, consultation, problem-solving and care planning, with high-level strategic direction and leadership of systemwide improvement efforts to improve clinical operational design, policy, protocols, and workflows to ensure high quality and patient-centered care to an underserved patient population. In general, this position will be responsible for developing and implementing the clinical infrastructure to ensure patients are referred and placed in appropriate housing options, with the necessary health and support services to improve health outcomes and maintain housing retention. The individual will be responsible for clinical management of the H+H medical respite facilities, which provide interim housing, clinical services and case management for patients experiencing homelessness who need more intensive support than would be available in the shelter system or on the streets.

HFH is seeking Board Certified/Eligible Advanced Practice Practitioner candidates with strong clinical skills and demonstrated experience working with people experiencing homelessness who have complex medical and/or behavioral health conditions. The position will report to the Assistant Vice President overseeing Housing for Health, with an indirect reporting line to the Medical Director. Successful candidates should also possess strong connections to the network of community-based health and support services for homelessness in NYC, leadership skills, and exceptional communication and organizational ability. This position will work both independently and as a collaborative partner within the hospital system, Housing for Health team, government agencies, supportive housing providers and other community-based organizations.

MAJOR AREAS OF RESPONSIBILITY:

Clinical Integration and Improvement: This position will further develop and manage HfH efforts to align and integrate programming into standard clinical workflows across ambulatory, inpatient and ED settings, aiming to promote the services available through HfH to develop a continuous pipeline of patients referred in need of housing. This will involve strengthening efforts on patient identification, referral processes, and supporting technology systems developing tools and training to build system capacity, and collaboration with key throughout the health system, including but not limited to program leads, housing champions, clinical providers, social workers, nurses, community health workers and other staff within H+H central office, hospitals and ambulatory care network. This will also include identifying and addressing barriers to housing placement and collaborating with internal and external stakeholders to address gaps through policy, regulatory and programmatic tools.

Clinical Referral Management: This position will be responsible for comprehensive clinical triage and assessment of referrals to Housing for Health for housing navigation and placement services, which may include determining appropriate permanent housing options and level of care needed, prioritization of need, assessing for required medical and social service supports, and coordinating with internal and external stakeholders to facilitate seamless, safe and effective transitions between settings. The individual will also be responsible for liaising with referring care teams to confirm longitudinal care needs are met, guiding partners through the process of establishing long term care benefits for appropriate patients and liaising with licensed/certified home care agencies. As needed, the Director may liaise with NYC Human Resource Administration and other city agencies to ensure patients are qualified for the appropriate housing type.

Respite Clinical Oversight: HFH contracts for with two non-profit vendors to provide medical respite services. The position will be responsible for development of clinical protocols and guidelines, referral management, including conducting comprehensive clinical assessments to determine patient eligibility and appropriateness for program services, and coordinating with referring healthcare providers and respite staff to facilitate seamless and safe transitions to medical respite. The position will also conduct clinical visit to medical respite sites, overseeing care plans for patients, coordinating delivery of clinical services, determining medical clearance, and supporting respite staff with discharge planning

Systemwide Clinical Consultation: This position will provide skilled and timely clinical advice at multiple points throughout its housing system. This consultation may include providing advice to referring partners prior to HFH referral, liaising between systemwide referral points and Housing Location and Placement Services vendor, and consultation with on-site providers at H+H contracted interim or permanent housing sites to problem solve specific client issues including triage of clinical need, and linkage to specialty care, primary care, behavioral health services, and other community resources.

Quality Improvement, Evaluation and Data Tracking: This position will be responsible for program wide quality improvement initiatives that target high quality and patient-centered care throughout the housing journey, aimed at achieving improved health care outcomes and residential stability. Additionally, this position would lead evaluations to determine if key metrics are being achieved and assist with data tracking and reporting as necessary.

Minimum Qualifications

1. A Master’s Degree from an accredited college or university in Public Health, Public, Hospital or Business

Administration, Health Care Specialization, Engineering, Social Services or a related discipline; and four (4)

years of progressively responsible experience relating to health care program planning, research, design,

operations, evaluation and analysis, one (1) year of which must have been in supervision or planning and/or

analysis; or

2. A Baccalaureate Degree from an accredited college or university in disciplines, as listed in #1 above; and five

(5) years of progressively, responsible experience relating to health care program planning, research, design,

operations, evaluation and analysis, one (1) year of which must have been in supervision or planning and/or

analysis; or

3. A satisfactorily equivalent combination of education and experience, in which 30 graduate-level semester

credits from an accredited college or university can be substituted for one year of experience. However, all

applicants must have at least a Bachelor’s Degree.

Department Preferences

Four (4) years of satisfactory, full-time experience in clinical practice

One (1) year experience working with patients experiencing homelessness in clinical or programmatic context

Microsoft Office Suite; Electronic Health Record, Epic, NowPow, and MyChart

Certifications:

• Board-certified (or board-eligible) and licensed to practice in NYS
• Licensed/certificated to work as Advanced Practice Practitioner in NYS
• Licensed to practice as LCSW in NYS

Educational Level:

• A bachelor’s degree from an accredited college or university in a specialization or discipline consistent with project content; and
• medical degree (MD or DO) or
• Masters-level degree that is accredited for Physician Assistants/Associates or Advanced Practice Registered Nurses.

Knowledgeable in:

• Affordable and supportive housing policy and programs.
• Strong understanding of the social determinants of health and the intersectionality of homelessness, mental health, substance use, and chronic medical conditions.
• Understanding of acute hospital and/or nursing home discharge planning processes including
• Knowledge of range of clinical services available for patients experiencing homelessness, including specialist clinics, embedded clinics and street medicine programs
• Excellent communication skills, with the ability to effectively engage with diverse stakeholders, including patients, caregivers, staff, and community partners.
• Commitment to equity, inclusion, and cultural humility in healthcare delivery, with experience serving marginalized and underserved populations.
• Familiarity with electronic health record systems and data management tools for program evaluation and quality improvement initiatives.
• Knowledge of population health, community health, and social determinants of health and/or health administration.
• Basic understanding of core concepts in quality improvement, including driver diagrams, PDSA cycles, run charts, and causes of variation.