Transition Specialist

About the Role

Responsible for supporting individuals transitioning from nursing facilities or other institutional settings into safe, accessible, community-based living through person-centered planning, options counseling, transition coordination, resource linkage, documentation, and follow-up services, as required by Show Me Homes/Money Follows the Person contract.

Responsibilities

• Direct Services
  • Provide person-centered options counseling, transition support, information, referrals, advocacy, and independent living skills training to individuals moving from institutional settings into the community.
  • Help participants identify goals, strengths, support systems, health and safety needs, housing preferences, and barriers to successful community living.
  • Assist with outreach and education activities that increase awareness of transition services, MFP, homeless services, and other community-based supports available to people with disabilities.
• Transition Services
  • Respond to referrals, conduct face-to-face sessions, and coordinate with participants, nursing facilities, state agency staff, families, guardians, and support teams.
  • Develop and implement individualized transition plans addressing housing, personal care, health supports, transportation, benefits, DME/assistive technology, household needs, and emergency backup planning.
  • Coordinate housing, community services, move-in needs, referrals, and required post-transition follow-up to support participant safety, satisfaction, and long-term stability.
  • Maintain an appropriate transition caseload, including an average caseload expectation as determined by program requirements.
• Reporting and Documentation
  • Maintain accurate, timely documentation of participant contacts, referrals, assessments, transition plans, follow-up visits, and service coordination activities in accordance with Paraquad policies, CARF standards, Money Follows the Person/DHSS requirements.
  • Complete required forms, reports, participant records, database entries, and program documentation in accordance with Paraquad, state agency, and funding requirements.
  • Provide updates to the IL Manager and participate in quality improvement activities related to documentation, service delivery, compliance, and outcomes.
• Miscellaneous
  • Complete other duties as assigned by the IL Manager or program leadership.
  • Follow agency policies, contract requirements, confidentiality standards, and mandated reporting expectations.
  • Represent Paraquad professionally and uphold the independent living philosophy, disability rights, participant choice, privacy, and community inclusion.

Requirements

• Education and Experience
  • Bachelor's degree in social work, psychology or counseling
  • OR Bachelor's degree plus a minimum of 2 years of relevant experience
  • OR Associate's degree plus a minimum of 4 years of relevant experience
  • OR Minimum of 8 years of relevant experience
• At least one year of experience in case management
• Personal experience with a disability or previous experience working with people with disabilities
• Understanding of and commitment to the independent living philosophy
• Working knowledge of disability and disability-related issues and methods of service delivery
• Reliable access to transportation is required to complete participant visits, community-based appointments, outreach activities, and other job-related travel.

Skills

• Active Listening and Interviewing
• Customer Service
• Professionalism
• Resourcefulness
• High Level of Organization
• Multi-tasking
• Time Management
• Oral/Written Communication
• Team Player
• Computer Literacy in Microsoft Office Programs and Database Environment

Working Conditions

• Must be able to remain in a stationary position 50% of the time.
• Needs to move about inside the office to access file cabinets, office machinery, etc. and positions self to maintain files in file cabinets.
• Constantly operates a computer and other office productivity machinery, such as copy machine, phone system, and computer printer.
• Must be able to communicate information and ideas so others will understand and must be able to exchange accurate information in these situations.
• Must be able to work full-time in office environment 36 hours per week and/or remote 4 hours per week. Occasional flexibility with schedule as needed.
• Requires travel within 30 miles of the office and further as necessary.