Part Time Community Transition Liaison

Minuteman Senior Services; Burlington (MA); On-site; USD 30,000 - 42,000; Part time

Job summary

Minuteman Senior Services is seeking a Community Transition Liaison in Burlington, MA to support nursing facility residents ages 22+ who want to transition to community living. The role includes assessments, planning, referrals, and collaboration with state programs to facilitate successful transitions.

The position combines remote work with site visits to nursing facilities, requires strong communication and data-entry skills, and adherence to HIPAA/MA privacy regulations.

Qualifications

• Experience with long-term care, discharge planning, and community resources.
• Strong interviewing and assessment skills.
• Ability to listen and create person-centered plans.
• Strong written and oral communication skills.

Responsibilities

• Visit residents to raise awareness of community supports and discuss transition options.
• Participate in resident and family conversations to inform options and transition plans.
• Conduct assessments to determine eligibility and plan transition to the community.
• Gather documentation for housing and public benefits applications.
• Complete referrals and follow up to ensure timely transition.
• Coordinate with state programs and teams and attend required trainings.

Skills

Data entry

Time management

Communication

Discharge planning

Tools

Microsoft Office Suite

Job description

Job DetailsJob Location: Burlington, MA 01803Salary Range: $26.00 - $26.00 HourlyHOURS PER WEEK: 17.5

GENERAL SUMMARY:

Under the supervision and guidance of the Community Transitions Supervisor, the Community Transition Liaison supports nursing facility residents (ages 22+) who want to consider transitioning to a community setting. This service includes both short-stay admissions and long-term residents. The program involves assisting to meet the unique needs of sub-populations, including those with criminal justice system involvement, behavioral health needs, specific diagnoses and individuals experiencing housing insecurity, and/or those who may require specialized referrals to state programs and supports and to other agencies for transition needs which are best met through other agencies.

ESSENTIAL FUNCTIONS:

• Community Transition Liaison supports nursing facility residents (ages 22+)
• Visit with residents to increase awareness of community support and services and introduce transition as a potential option;
• Participate in resident and family conversations to inform options and transition plan;
• Conduct assessments to determine eligibility and help with planning transition to the community;
• Begin the process of gathering all necessary documentation and identification needed for application for housing and other public benefits;
• Complete referrals to other programs and follow up on referrals to ensure timely transition;
• Identifies individuals appropriate for CTLP based on resident’s desire to transition to community living environment, including use of PASRR portal to facilitate resident identification
• Participates and facilitates in discharge planning meetings with the consumer, family, nursing facility staff, and other agencies that will support the consumer in the community upon discharge
• Liaison with nursing and other professionals at the SNF; and
• Coordinate with state programs and teams
• Attend required meetings and complete required trainings
• Other duties as assigned

COMPETENCIES NEEDED:

• Must be a self-starter and can work in a fast-paced environment with multiple interruptions.
• Must possess excellent time management and problem-solving skills, along with the ability to establish and maintain professional boundaries and manage multiple priorities.
• Must have accurate and fast data entry computer skills and experience using all Microsoft Suite programs.
• Ability to work well with people of all backgrounds, incomes, ages, races, and abilities (i.e., mental health, physical, cognitive, sensory).

WORK ENVIRONMENT:

This job is remote and visiting nursing facilities - occasional office meetings and regularly requires the use of a computer, telephone, and other standard office equipment. When on home visits or other meetings, the employee travels by car and is exposed to changing weather and seasonal conditions.

PHI and PII:

This role has access to Protected Health Information (PHI) and therefore the employee must adhere to Minuteman’s confidentiality policy and HIPAA regulations.

This role has access to Personal Identifiable Information (PII) and therefore the employee must adhere to Minuteman’s confidentiality policy and MA Executive Order 504.

This role has access to Protected Health Information (PHI) and Personal Identifiable Information (PII) and therefore the employee must adhere to Minuteman’s confidentiality policy, HIPAA regulations, and MA Executive Order 504.

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and alignment with the role’s responsibilities.

QUALIFIED APPLICANTS WILL HAVE:

• Willingness and sensitivity to work with individuals with complex health needs
• Strong interviewing and assessment skills
• Ability to listen and create person-centered plans
• Strong written and oral communication skills
• Strong computer skills include data entry, management of electronic health records, and Microsoft Suite
• Familiarity with and/or willingness to learn about all relevant health and human service programs and agencies available
• Must possess knowledge of long-term care, case management, discharge planning, community resources, programs, and benefits to help an individual’s transition from an institution to a community setting
• Must have reliable transportation and a valid driver’s license in good standing