Reentry Care Coordinator

at State of Vermont in Springfield, Vermont, United States

Job Description

The Re-Entry Care Coordinator plays a key role in supporting individuals transitioning from incarceration back into the community. This position focuses on reducing recidivism, promoting community integration, and improving health and social outcomes by connecting individuals to critical services such as housing, healthcare, substance use treatment, employment, and mental health supports. The re-entry care coordinator will utilize a team-based care approach to care coordination and will serve Vermonters with complex health and social needs as well as people transitioning from incarceration to community. 

Key Responsibilities
•    Pre-release planning: Collaborate with correctional facilities, probation/parole officers, and facility-based service providers to identify and engage eligible individuals prior to release.
•    Individualized care coordination: Develop shared care support plans tailored to individual needs, goals, and risk factors. Convene and facilitate care conferences among providers. 
•    Service navigation: Connect clients to housing, medical care, behavioral health services, benefits (e.g., Medicaid, SNAP),  employment, and peer support resources.
•    Case management: Provide intensive case management for Vermonters experiencing high needs across the various systems of care.  Case management is provided 90 days pre-release and 3-6 months post-release, including in-person and virtual check-ins for justice involved clients. Facilitate care conferences for individuals being served. Connect people to crisis services as needed and appropriate. 
•    System collaboration: Participate in multidisciplinary team meetings (e.g., situation tables, re-entry councils, or public safety partnerships), Dept of Corrections meetings, Local Interagency teams, etc. 
•    Documentation & data tracking: Maintain accurate records in designated systems and track outcomes (e.g., service access, housing stability, recidivism).
•    Community outreach: Build partnerships with service providers and engage in community events to strengthen the re-entry support network.
•    Advocacy: Support individuals in navigating stigma, legal barriers, and systemic challenges. Provide warm hand offs to service providers.

Travel is required between facilities, community agencies, and client homes. May include occasional evening or weekend hours. Work is performed in correctional facilities, in the community and in an office-based setting.