Transition Coordinator

Job Description

Job Description

JOB DESCRIPTION : TRANSITION COORDINATOR

Full Time. $25-$28 / hr., Salary depending on degree, experience and healthcare coordination background.

Bonus : $1000 after successful completion of required State transition coordination certification within three months. $1000 additional bonus after six months of satisfactory employment.

General : Facilitate and coordinate the transition of individuals from nursing facilities to independent living arrangements.

Work closely with the Housing Program Coordinator to ensure seamless transition while maintaining compliance with State documentation requirements and timeline management.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Assess and identify nursing facility residents who are candidates for transition to independent living arrangements
• Develop and maintain relationships with nursing facilities, social workers, and discharge planning staff
• Complete comprehensive transition assessments and develop detailed transition plans in accordance with State requirements
• Coordinate with Housing Program Coordinator to align housing availability with discharge timing
• Ensure all required State documentation is complete and accurately maintained throughout the transition process
• Conduct regular visits with clients in nursing facilities to monitor progress and address concerns
• Coordinate with healthcare providers to ensure continuity of care during and after transition
• Develop and maintain comprehensive service plans including medical equipment needs, home modifications, and support services
• Facilitate communication between all stakeholders including clients, families, healthcare providers, and housing coordinators
• Track and document all transition activities in State-mandated systems and agency databases
• Participate in care planning meetings and provide advocacy for clients as needed
• Monitor client progress post-transition to ensure successful community integration
• Identify and address potential barriers to successful transition
• Maintain accurate and detailed records of all client interactions and transition milestones

REQUIREMENTS AND QUALIFICATIONS

• Bachelor's degree in Social Work, Healthcare Administration, or related field required
• Minimum of 2 years experience in healthcare coordination, discharge planning, or similar role
• Strong understanding of medical terminology and healthcare systems
• Excellent organizational skills with demonstrated ability to manage multiple complex cases
• Superior attention to detail, particularly in documentation and compliance requirements
• Strong interpersonal skills and ability to work with diverse populations
• Proficiency in Microsoft Office Suite and ability to learn state-specific database systems
• Experience with person-centered planning and knowledge of community resources
• Understanding of Medicaid / Medicare regulations and requirements preferred
• Ability to work both independently and as part of a collaborative team
• Must be able to travel throughout the service area
• Valid driver's license and reliable transportation required
• Experience working with individuals with disabilities preferred
1 day ago