What are the responsibilities and job description for the Transition Care Specialist position at DC Department of Human Resources?
Job Summary
The D.C. Department of Aging and Community Living (DACL) develops and carries out a comprehensive and coordinated system of health, education and social services for the District's older adults (60 years and older), people with disabilities (18 years and older), and their caregivers. The mission of the District of Columbia Department of Aging and Community Living is to advocate, plan, implement, and monitor programs in health, education, and social services for the elderly; to promote longevity, independence, dignity, and choice for aged District residents, District residents with disabilities regardless of age, and caregivers; to ensure the rights of older adults and their families, and prevent their abuse, neglect, and exploitation; to uphold the core values of service excellence, respect, compassion, integrity, and accountability; and to lead efforts to strengthen service delivery and capacity by engaging community stakeholders and partners to leverage resources.
The Transition Care Specialist position is part of the Nursing Home transition team and works with individuals to prepare for and transition from the facility to the community.
Duties And Responsibilities
The Transition Care Specialist, working with the client and their formal/informal supports, will determine eligibility for waiver services, provide information and linkages to community services and will assist the NH in planning a safe transition for the individual. The TCS will work with the client for up to 30 days post discharge from the nursing home. Collaborates with the consumer and the interdisciplinary team to develop a Plan of Care to include in the comprehensive Person-Centered Transition Plan (PCIP) prior to the move. Assists with linkages to employment options if participant indicates interest. Assists the individual in locating community resources such as a physician, pharmacy, etc., as needed and as directed by the individual and acts as a resource or consultant on community integration.
Is present at the participant's home on the day of discharge from the nursing facility to support the client and verify that community supports are in place. Provides case management services in person and by telephone to consumer for 30 days post discharge. Assists the consumer to apply for public benefits to include Medicaid/waiver financed services and other supports (e.g. medical, financial, counseling, housing, adult day care, and personal assistance) that will support the individual in the community.
Qualifications And Education
Degree: behavioral or social science; or related disciplines appropriate to the position.
or
Combination of education and experience that provided the applicant with knowledge of one or more of the behavioral or social sciences equivalent to a major in the field.
or
Four years of appropriate experience that demonstrated that the applicant has acquired knowledge of one or more of the behavioral or social sciences equivalent to a major in the field.
In addition: Applicants must possess one (1) year of specialized experience equivalent to at least the next lower grade in the normal line of progression. Specialized experience is experience that has equipped the applicant with the knowledge, skills, and abilities to successfully perform the duties of the position and include work directly related to the coordination and delivery of social services; assisting with obtaining community resources and Medicaid benefits; or similar work experience.
Licenses and Certifications
None
Work Conditions/Environment
The work is generally performed in the normal office setting, but may require home visits, or meetings in other community settings.
Other Significant Facts
Tour of Duty: Monday – Friday 8:15 a.m. to 4:45 p.m.
Pay Plan, Series and Grade, CS-0101-12
Promotion Potential: No Known Promotion Potential
Collective Bargaining Unit (Non-Union): This position is not in the collective bargaining unit.
Position Designation: The incumbent of this position will be subject to enhanced suitability screening pursuant to Chapter 4 of DC Personnel Regulations, Suitability - Safety Sensitive.
EEO Statement: The District of Columbia Government is an Equal Opportunity Employer. All qualified candidates will receive consideration without regard to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, physical handicap, or political affiliation.
The D.C. Department of Aging and Community Living (DACL) develops and carries out a comprehensive and coordinated system of health, education and social services for the District's older adults (60 years and older), people with disabilities (18 years and older), and their caregivers. The mission of the District of Columbia Department of Aging and Community Living is to advocate, plan, implement, and monitor programs in health, education, and social services for the elderly; to promote longevity, independence, dignity, and choice for aged District residents, District residents with disabilities regardless of age, and caregivers; to ensure the rights of older adults and their families, and prevent their abuse, neglect, and exploitation; to uphold the core values of service excellence, respect, compassion, integrity, and accountability; and to lead efforts to strengthen service delivery and capacity by engaging community stakeholders and partners to leverage resources.
The Transition Care Specialist position is part of the Nursing Home transition team and works with individuals to prepare for and transition from the facility to the community.
Duties And Responsibilities
The Transition Care Specialist, working with the client and their formal/informal supports, will determine eligibility for waiver services, provide information and linkages to community services and will assist the NH in planning a safe transition for the individual. The TCS will work with the client for up to 30 days post discharge from the nursing home. Collaborates with the consumer and the interdisciplinary team to develop a Plan of Care to include in the comprehensive Person-Centered Transition Plan (PCIP) prior to the move. Assists with linkages to employment options if participant indicates interest. Assists the individual in locating community resources such as a physician, pharmacy, etc., as needed and as directed by the individual and acts as a resource or consultant on community integration.
Is present at the participant's home on the day of discharge from the nursing facility to support the client and verify that community supports are in place. Provides case management services in person and by telephone to consumer for 30 days post discharge. Assists the consumer to apply for public benefits to include Medicaid/waiver financed services and other supports (e.g. medical, financial, counseling, housing, adult day care, and personal assistance) that will support the individual in the community.
Qualifications And Education
Degree: behavioral or social science; or related disciplines appropriate to the position.
or
Combination of education and experience that provided the applicant with knowledge of one or more of the behavioral or social sciences equivalent to a major in the field.
or
Four years of appropriate experience that demonstrated that the applicant has acquired knowledge of one or more of the behavioral or social sciences equivalent to a major in the field.
In addition: Applicants must possess one (1) year of specialized experience equivalent to at least the next lower grade in the normal line of progression. Specialized experience is experience that has equipped the applicant with the knowledge, skills, and abilities to successfully perform the duties of the position and include work directly related to the coordination and delivery of social services; assisting with obtaining community resources and Medicaid benefits; or similar work experience.
Licenses and Certifications
None
Work Conditions/Environment
The work is generally performed in the normal office setting, but may require home visits, or meetings in other community settings.
Other Significant Facts
Tour of Duty: Monday – Friday 8:15 a.m. to 4:45 p.m.
Pay Plan, Series and Grade, CS-0101-12
Promotion Potential: No Known Promotion Potential
Collective Bargaining Unit (Non-Union): This position is not in the collective bargaining unit.
Position Designation: The incumbent of this position will be subject to enhanced suitability screening pursuant to Chapter 4 of DC Personnel Regulations, Suitability - Safety Sensitive.
EEO Statement: The District of Columbia Government is an Equal Opportunity Employer. All qualified candidates will receive consideration without regard to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, physical handicap, or political affiliation.
