Coastline is currently accepting resumes for a Full-Time, Community Transition Liaison Program Coordinator in the Home Care Department. The successful candidate will report to the Home Care Nursing Supervisor.
The Community Transition Liaison Program Coordinator will provide consumers who wish to transition from institutional setting into the community with options, resources, and assistance. The Community Transition Liaison Program Coordinator will actively collaborate with RN’s and/or Care Managers, nursing facilities and other programs or community resources and consumers with unique needs who may require specialized supports and care plans in favor of fostering meaningful community living.
Qualifications & Essential Functions
- Acts as onsite point of contact for residents, families, health care proxy (HCP) and nursing facility (NF) staff related to transitions from NF to community. Visits with residents to increase awareness of service and introduce transition to the community as a potential option.
- Participates in resident, family and/or HCP conversation to inform options and transition planning.
- Completes the directional screening tool to determine potential appropriateness for referrals to HCBS Waivers and other programs to support the transition to the community and meet the consumer’s needs once in the community setting.
- Begins the process of gathering necessary documentation and identification needed for housing applications and other public benefits. Completes referrals to other programs and follows-up on referrals to ensure timely transition.
- Participates in Interdisciplinary Discharge Planning (IDP) meetings and facilitates communication among consumer, family members and community agencies. Facilitates person-centered planning and needs assessment.
- Participates and facilitates in discharge planning meetings with consumer, family, nursing facility staff and other agencies that will support the consumer in the community upon discharge.
- Coordinates with state programs and teams. Completes documentation as necessary and required by EOEA for the CTL Program.
- Performs other duties as may be required.
- Bachelor’s Degree in social work, human services, nursing, psychology, sociology or a related field and demonstrates experience in the field of human services via previous employment, internship, or volunteer activity and/or additional studies.
- Must possess knowledge of long-term care, case management, discharge planning, community resources, programs, and benefits to help support an individual’s transition form an institutional to a community setting.
- Preferably fluent in Portuguese, Spanish or Creole but not required.
- Valid MA Driver’s License and daily access to a dependable vehicle.
Suitable candidates are encouraged to apply.
Please send your cover letter and resume to: Susan Garriga, Employment Manager, at sgarriga@coastlinenb.org
You may also apply online by following the link below or please stop by Coastline for an application.