Provide street-based case management to unhoused individuals in Sonoma Valley to guide them toward permanent housing. Coordinate community resources, conduct intakes, and maintain detailed documentation in the HMIS database.
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We deliver exceptional service to our communities. PROGRAM OVERVIEW The Sonoma Valley Street Outreach Team's purpose is to connect street and encampment homeless individuals to permanent housing and address immediate safety concerns such as connection to emergency shelter. These caseloads include targeted subpopulations of people experiencing chronic homelessness, people benefitting from housing problem solving techniques, and people who need support with the final stages of pre and post-housing. Outreach Case Managers carry dedicated caseloads of 18 guided by the Sonoma Valley By-Name-List and the county-wide Coordinated Entry System (CES) By-Name-List and processes. In addition, program staff spend limited time each week conducting “general” outreach at consistent locations and on an ad hoc basis responding to calls. The Sonoma Valley Outreach Team consists of two agencies, HomeFirst and SAVS, who will partner to provide two part time street outreach case management staff and comprehensive program management. The Outreach Case Manager is accountable to contract caseload utilization and permanent housing outcomes, documentation and policy compliance, and maintaining effective partnerships in the community.
This is a Full-time position totaling 30 hours per week. REPORTING RELATIONSHIP This role reports to the Program Manager. PRIMARY RESPONSIBILITIES Direct Services (70%) Provide street and encampment-based case management to unhoused participants throughout the Sonoma Valley region. Effectively guides case load participants through the system of care to permanent housing outcomes. Provide linkage and coordinate services to community resources, including health care and shelter, vital documents and benefits applications, family reunification, Housing Problem Solving, etcetera.
Utilizes best practices in homeless services including: Harm Reduction, Trauma-Informed Care, Motivational Interviewing, Crisis Prevention and Intervention, and Safety Planning. Facilitates provision of financial assistance and basic needs items as appropriate to ensure safety, relationship-building, and movement towards permanent housing. Proactively advocates for participants and collaborates with community partners regarding supportive services. Conducts client intake, including full Coordinated Entry Assessment, as requested by participants and guided by Sonoma Valley By-Name-List. Works with program participants to develop and implement an individual case management plan and provide support to help them achieve their housing and personal goals. Meets regularly with program participants at a frequency determined by the participants’ needs. Provide transportation of participants to critical appointments, housing move-ins, shelter, and additional destinations. Limited outside of standard hours support expected when it would benefit participants or to complete resolution of emergency response that begins during standard hours. Assist with other duties as assigned. Documentation (20%) Documents, via progress notes in HMIS, all case management activity within five business days. Maintains physical case file paperwork and documentation. Participates in ongoing analysis of and program alignment with industry best practices. Proactively and consistently improves the quality and effectiveness of program services. Conducts ongoing re-assessments of the client's needs and status and documents assessment in the Homeless Management Information System database. General (10%) Attends all meetings and training relevant to this position. Assist with office-related tasks as needed. Works collaboratively with Program Coordinator and utilizes supervision appropriately, maintaining open lines of communication and providing updates on participants’ progress towards goals. Attends the Sonoma Valley By-Name-List meeting and reports out on progress with participants as needed. Properly reports any suspected cases of abuse. Maintains professional relations and conduct. Knows and implements agency, program, and applicable county standards and policies and procedures. Other duties as assigned.
QUALITIES: The Outreach Case Manager prefers fieldwork over office-based work, and is self-driven and flexible in a day-to-day that rarely follows expectations. The Outreach Case Manager has a “whatever it takes” approach to moving people into housing, meeting barriers with creativity and meeting clients where they are. The Outreach Case Manager is highly collaborative and enjoys a team-oriented environment. They actively drive progress towards shared goals for their participants among varying service providers. This position will manage a caseload of 18 highly vulnerable individuals with different goals and housing plans; the Outreach Case Manager must be organized and accountable to multiple priorities. HomeFirst is a diverse company in a diverse field, and the Outreach Case Manager desires to work with people from a variety of social and economic backgrounds. Skills and Abilities Understanding of and sensitivity to the needs of the unhoused population. Ability to develop relationships with community partners and outside agencies. Ability to develop and maintain priorities and meet established deadlines. Ability to present oneself and the agency professionally to internal and external audiences. Ability to walk long distances on rough terrain (such as trails, creek sides, and high-traffic areas. Ability to lift and carry outreach supplies (usually in a backpack, up to 30 lbs.). General Other duties as assigned. Strong written and oral communication skills. Proficient in Microsoft Word, Outlook and basic elements of Excel. Valid CA driver’s license and insurance, and reliable vehicle to use on the job (mileage provided). BENEFITS HomeFirst provides comprehensive benefits, including 100% employer-paid medical, dental, and vision coverage and additional wellness options like chiropractic care, mental health support, pet insurance, and an Employee Assistance Program. We offer a 401(k)-retirement plan with generous matching, life and disability insurance, flexible spending accounts, commuter benefits, and workers’ compensation. Employees enjoy 12 holidays, sick leave, and PTO starting at 15 days annually, increasing with tenure, plus 8 hours of civic engagement leave annually to volunteer. ORGANIZATIONAL EQUITY STATEMENT At HomeFirst, diversity, equity, and inclusion guide our services, workplace, and decisions. Recognizing housing as a social justice issue, we prioritize equitable practices, honor lived experiences and uphold dignity for all. By fostering belonging, accountability, and continuous improvement, we embed DEI values in our processes, recruitment, and leadership, striving for excellence at every level. HomeFirst is proud to be an Equal Opportunity and Affirmative Action employer and considers qualified applicants for employment without regard to race, color, creed, religion, national origin, sex, sexual orientation, gender identity, age, disability, veteran status, or any other status protected by law. We also consider qualified applicants with criminal histories, consistent with applicable federal, state, and local law. Additionally, HomeFirst participates in the E-Verify program, as required by law. HomeFirst is committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans in our job application process. If you need assistance or an accommodation due to a disability, please let your recruiter know. QualificationsQUALIFICATIONS (YOU HAVE) Knowledge and Experience People with lived experience encouraged to apply. 1 year experience in human services. Bachelor of Arts in Social Work (BASW) degree or related human services field preferred, not required. Bilingual in Spanish and bicultural preferred, not required
Requires a high school diploma and one year of experience in human services, with a bachelor's degree in social work preferred. Must possess a valid CA driver's license, a reliable vehicle, and the physical ability to walk long distances on rough terrain.
Market context
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