TCL Transition Coordinator (Hybrid, Morrisville, North Carolina based)

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