Position eligible for – 

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs

See attachment for additional details. 

Office Location: Serving Gaston County

Projected Hiring Range: Depending on Experience

Closing Date: Open Until Filled

Primary Purpose of Position:

This position is responsible for providing proactive intervention and coordination services to persons residing in institutionalized settings prior to their transition to home and community based services as part of the Transitions to Community Living Initiative. Ensures that the specific functions related to the Department of Justice Transition process is followed and addressed. These services prepare individuals for discharge and assists during adjustment period immediately following discharge from an institution.

Role and Responsibilities:

• Responsible for coordination and oversight of all in-reach activities and for leading the transition/discharge planning process
• Ensures that any individual who wishes to move to a more integrated setting from the adult care home or state psychiatric hospital is provided with necessary services and supports
• Assists the individual in developing an effective written plan to enable the individual to live independently in an integrated community setting
• Assists in identification of barriers and in development of strategies to address those barriers
• Works with the individual and the individual’s family and supports to develop a thoughtful, organized transition plan that addresses his/her community-based support needs
• Ensures discharge/transition planning is developed and implemented through person-centered planning processes in which the individual has a primary role and is based on the principle of self-determination
• Coordinate with the individual, his/her family and supports to identify and secure the community resources necessary to transition. This includes but is not limited to: housing, behavioral health services, medical care, financial management and other community supports that are needed for community living
• Conduct Initial Quality of Life Survey
• Completes joint, post transition follow-up in coordination with licensed Care Coordinator
• Conducts ongoing communication with the transitioning individual, his/her supports, facility and community provider staff throughout the transition process
• Works closely with the In-Reach staff, community based care coordination, hospital liaisons and other agency departments necessary to create, implement and fulfill appropriate and successful transition planning with members eligible for services and supports under the NC Transitions to Community Living Initiative
• Assures data is tracked and all reporting requirements are met
• Other specific functions as they relate to Diversion, In-Reach, Transition Process and Post-Transition responsibilities as indicated from DMA/DMH
• Performs related tasks as required

Knowledge, Skills and Abilities:

• Extensive understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version)
• Considerable knowledge of the MH/SU/DD service array and the network of the LME/MCO’s providers
• Knowledge of best practices for individuals with MHSU needs
• Knowledge of the LME/MCO’s implementation of the 1915 (b/c) waivers and national accreditation
• Exceptional interpersonal skills and be able to communicate effectively with individuals/families supported, service providers, community agencies, other employees and a variety of other community members
• Highly skilled at assuring that both long and short range goals and needs of the individual are addressed and updated, while also assuring through monitoring activities that service implementation is occurring appropriately
• Problem solving, negotiation, arbitration, and conflict resolution skills are essential to balance the needs of both internal and external customers
• Excellent computer skills including proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint
• Detail-oriented, able to organize multiple tasks and priorities and to effectively manage projects from start to finish
• Ability to communicate by telephone or other electronic device when working in the community, out of the office
• Ability to see the person and his/her family as central individuals in the transition process, taking on responsibilities in the transition work
• Ability to demonstrate flexibility and adaptability
• Ability to make prompt independent decisions based upon relevant facts
• Exhibit sensitivities to cultural differences present in service populations
• A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance

Education/Experience Required:

• Bachelor’s degree in a human services field plus three (3) years of relevant experience working directly with individuals with SMI or SED; OR
• Master’s degree in a human services field or licensure as a registered nurse (RN), plus one (1) year of relevant experience working directly with individuals with SMI or SED;

AND

• Must be knowledgeable about resources, supports, services and opportunities required for safe community living for populations receiving in-reach and transition services, including LTSS, BH, therapeutic, and physical health services

Other requirements:

1. Must reside in North Carolina.
2. Must have ability to travel as needed to perform the job duties

Education/Experience Preferred: Above requirements

Licensure/Certification Requirements: N/A