Community Transition Care Coordinator

Transitional Services for New York, Inc.

New York (NY)

On-site

USD 45,000 - 55,000

Full time

11 days ago

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Job summary

Transitional Services for New York, Inc. (TSINY) is a not-for-profit mental health organization based in New York City.

The organization seeks an Adult Home Care Coordinator for its Outreach Program in Jamaica, Queens, NY to provide intensive care management to Adult Home class members transitioning to community living. The role involves collaboration with an interdisciplinary team, discharge planning, coordinating housing and health home services, and maintaining regular contact with clients

Qualifications

Bachelor’s degree in social work or related human services field.
NYS teacher certification with bachelor’s degree.
NYS RN license with bachelor’s degree.
Bachelor’s or higher with 5 years experience in behavioral health.
CASAC credential.

Responsibilities

Evaluate class member’s interest in transitioning from the adult home to the community.
Educate about the benefits of transitioning to community living.
Refer to Housing Contractor for in-reach upon transition interest.
Enroll in Health Home if not transitioning; obtain Health Home Consent Form.
Enroll in Health Home and obtain consent if transitioning.
Complete the Discharge Planning Tool (DTP) and forward to the Community Transition Coordinator two business days before the pre-transition call.
Participate in all pre- and post-transition calls.
Provide at least four face-to-face contacts with the class member monthly.
Conduct monthly phone and/or face-to-face contacts with Housing Contractor.
Participate in weekly telephonic calls with NYSDOH to share information about the class member.
Review need for securing identification and benefits; assist or undertake applications/renewals.
Assist movement from the adult home into the community.
Post-transition, support per care plan and reassess needs after five months.
Maintain or graduate from Adult Home Plus services as appropriate.
Continue weekly contacts until graduation.
Document all Health Home Core Services and other services provided.
Be able to sit or stand as needed with/without accommodation.
Be able to travel independently by public transportation.
May require lifting or filing duties with/without accommodation.
During a disaster, follow Disaster Preparedness Plan.
Perform other related duties as required.