The TCL Transition Coordinator is responsible for assisting individuals who have agreed to community living exiting an institutional care setting. This position will support a person in securing and managing appropriate services, housing and community resources and requires a high level of collaboration and problem solving with internal and external stakeholders.
This position will allow the successful candidate to work a primarily remote schedule. One day a week working onsite is required.
Responsibilities & Duties
Conduct Assessments and Planning
Assist the treatment team with members transitioning to the community from institutional care settings to community-based care
Utilize person centered planning, motivational interviewing and assessments to review information and develop rapport with the members supported
Obtain necessary releases of information that will improve care management activities on behalf of the member
Provide education and supports to members and legal guardians regarding their rights and responsibilities, available service options, providers availability, and payer requirements that may impact service connection and maintenance
Actively collaborate with members supported and members of the planning team to ensure development of a plan that accurately reflects the individual’s needs and desired life goals
Ensure that assessments and plans are updated, as needed, whenever the members’ life circumstances change
Complete Administrative assessments/ plans of care for the needs identified in the assessments and complete the interventions identified as needed
Ensure compliance with all DOJ Settlement requirements and adhere to best practice standards for assessments and treatment planning
Coordinate and Lead community transitions
Review BH crisis plans and care plans to ensure the presence of integrated care interventions and these plans reflect the needs and desires of members
Ensure that all team members and stakeholders involved with the member are aware of how to train, manage and mitigate crisis events, behavioral and physical, that the member may experience
Escalate high risk/high visibility and/or complex barriers/needs members who may have SDOH/Behavioral/Physical needs to treatment team for additional supports
Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues that includes face to face member visits as outlined in DHHS Transition manual
Ensure compliance with all DOJ Settlement requirements including the comprehensive core responsibilities outlined in the DHHS In Reach/Transition and Diversion manual
Distribute surveys to members, who are receiving services
Verify that initial service linkage is completed through monitoring of activities in JIVA
Verify members Medicaid and promptly follow up on identified issues.
Monitor and ensure the provision of community services for at least 90 days post transition emphasizing tenancy stability. Resolve any conflict or inadequate care with provider
Follow all TCL policies and procedures
Maintain Documentation
Ensures all documentation (e.g. goals, plans, progress notes, etc.) meet state, organization, and Medicaid requirements
Monitor documentation to ensure that issue/errors are resolved
Follow administrative procedures and effectively manage caseload
Ensure timely documentation into state required TCL platforms
Minimum Requirements
Education & Experience
Required:
Bachelor’s degree from an accredited college or university in a Human Services or related field and three (3) years of experience with the population served.
Preferred:
Master’s degree in human services and one (1) year of Full Time, Post degree work experience with social service agencies preferred.
Knowledge, Skills, & Abilities
Knowledge of resources and systems in the community that can assist with eliminating SDOH barriers to treatment and whole person living.
A high level of diplomacy and discretion is required
Problem solving, negotiation, arbitration and conflict resolution skills
Must be highly skilled at shifting between macro and micro level planning
Detail oriented
Ability to organize multiple tasks and priorities, and to effectively manage projects from start to finish.
Work activities and quickly adapt to mandated changes and priorities within the department.
The ability to change the focus of his/her activities to meet changing priorities.
Proficiency in Microsoft Office products (such as Word, Excel, Outlook, PowerPoint, etc.) is required.
Salary Range
$25 -$31.88/Hourly
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
Medical, Dental, Vision, Life, Long and Short-Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
