Transition Specialist

About the role

The Open Doors Transition Specialist facilitates the move of individuals from institutions (such as hospitals, nursing homes, or intermittent care facilities) to community-based settings by developing discharge plans, educating on community services, and providing one-on-one advocacy.

Requirements

• Associate Degree in Health, Human Services, or related field, or equivalent experience
• Experience working within the Long-Term Care system

Skills

• Strong commitment to the independent living philosophy, Person Centered Planning, consumer choice and integration of people with disabilities into all aspects of community life
• Knowledge of various Medicaid waivers and programs: TBI, NHTD, OPWDD, MLTC/MMCs
• Knowledge of services, community supports and benefit programs available to people with disabilities
• Knowledge of different disabling conditions
• Ability to effectively interact and work with individuals from diverse cultures and backgrounds
• Proficient in the use of all Microsoft Office applications (Excel, Word, Power Point)
• Ability to communicate effectively, both verbally and in writing
• Demonstrate professional work habits including dependability, time management, meet deadlines, independence, and responsibility
• Knowledge of ethical and professional responsibilities and boundaries
• Excellent attention to detail and organizational skills
• Ability to multi-task and work effectively in both a team and individual setting
• Capacity to work in various settings, including home visits and community-based locations
• Valid driver's license, access to a reliable and insured vehicle, and compliance with all applicable state regulations, including required vehicle inspections and driving record checks

Responsibilities

• Comply with all STIC policies and procedures, as well as applicable state and federal laws and regulations
• Receive and process referrals from lead coordinator, NYAIL, facilities, individuals and family members and ensure the transition process is coordinated for each individual
• Provide information and assistance for individuals and families who are considering or are in the process of transitioning from an institution to living in the community
• Assist and advocate for participant to develop a person-centered transition plan
• Coordinate visits to institutions and homes to provide unbiased information on home and community-based services to individuals, participate in discharge planning, and coordinate with other relevant social services agencies involved in the discharge and transition care of the individual
• Represent the Open Doors program at all implementation, development, and outreach meetings
• Collaborate with New York Association on Independent Living (NYAIL) staff to determine and resolve barriers to transition
• Ensure all significant individual data and service provision details are current and accurate and that they are documented in a timely manner into the NYAIL database
• Comply with all agency policies and procedures including HIPAA, confidentiality, code of ethics, etc.
• Collect and maintain all required statistical and other data and prepare reports within established timeframes
• Attend all mandatory agency and departmental trainings, meetings, and sign language class and advocacy groups
• Perform all other duties relevant to the position as requested

Physical Requirements/Working Conditions

Ability to sit/stand throughout day to accomplish job. Ability to reach above shoulder level. Ability to turn/twist upper body. Ability to enter data, notes, and other documentation into a computer. Must be able to travel throughout Broome, Tioga, and Chenango counties.