Health Related Social Coordinator - AD

Health Related Social Needs Coordinator - AD277

Company: Native American Rehabilitation Association of the Northwest, Inc. (NARA)

Location: River House, 211 SE Caruthers, Portland, OR 97214

Schedule: Monday through Friday, 8:00 am – 5:00 pm (in person)

Wage Range: $24.00 – $29.00 per hour, non‑exempt

Senior Level: Entry level

Employment Type: Full‑time

The Health‑Related Social Needs (HRSN) Coordinator addresses social determinants of health, focusing on housing instability and homelessness. The role supports individuals in accessing HRSN benefits through screening, coordination, and ongoing support. Responsibilities include managing closed‑loop referrals, invoicing, and documentation while collaborating with the social services team, housing providers, and community‑based organizations.

• Identify individuals eligible for HRSN benefits and services.
• Develop individualized housing support plans in collaboration with participants, care teams, and housing partners.
• Coordinate referrals to housing providers, supportive programs, and community‑based organizations using Unite Us and other closed‑loop referral software.
• Provide housing navigation and tenancy support services, including assistance with housing applications, move‑in readiness, and tenancy stabilization.
• Conduct ongoing follow‑up to support housing stability and continuity of care.
• Track housing‑related referrals, services, and outcomes in Unite Us, electronic health records, and other required data systems.
• Complete invoicing and documentation for housing‑related HRSN services in accordance with program, payer, and grant requirements.
• Serve as a liaison between care coordination teams, housing agencies, and community partners.
• Educate participants on housing resources, program expectations, and participant responsibilities.
• Maintain accurate, timely, and compliant documentation.
• Participate in interdisciplinary team meetings, case reviews, and housing‑focused case conferences.
• Stay current on available HRSN benefits, housing resources, and best practices related to housing stability.
• Maintain high level knowledge of all internal NARA NW programs, qualifications, and intake processes.
• Work collaboratively with staff and maintain professional boundaries, treating everyone with respect and dignity at all times.

• Maintain working knowledge of community services and resources, including Aging and Disability Services, Housing Assistance, Transportation, Food/Shelter Services, and Public Health resources.
• Provide culturally informed support to staff working directly with clients to ensure culturally responsive service delivery.
• Perform other duties as assigned.

Preferred qualifications include strong communication and organizational skills, knowledge of housing and social services, and a commitment to cultural competence. A background in social work or a related field is preferred.

Details about benefits are not provided in the original description; candidates should consult the company website for comprehensive information.