The Transition & Assessment Coordinator facilitates nursing home transitions and conducts comprehensive needs assessments to support participant outcomes. They also serve as an educational liaison to nursing facilities regarding specialized services and regulatory requirements.
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Job Summary and Responsibilities
Acentra Health is looking for a Transition & Assessment Coordinator, Mid to join our growing team.
The Transition and Assessment Coordinator is responsible for coordinating and facilitates Specialized Services (SS), Nursing Home Transition (NHT), and Needs Assessment activities in alignment with contractual requirements to support positive participant outcomes and a high-quality customer experience. The role also serves as a resource on OLTL requirements and updates and functions as an educational liaison to nursing facility staff regarding SS, NHT, and PCEDME services.
Utilize independent judgment, critical thinking, and knowledge of the needs of individuals with intellectual disabilities and/or autism to conduct comprehensive Needs Assessments and support person-centered service planning as identified by ODP. Provide Specialized Services (SS) in accordance with contractual requirements, program standards, and established performance expectations as determined by OLTL. Facilitate Nursing Home Transition (NHT) activities by identifying, coordinating, and securing community housing, services, resources and supports to promote successful community integration and long-term stability for eligible participants. Develop and maintain registry of community-based resources, housing options, and service networks to support successful participant outcomes and community integration across service area. Complete recommendations, documentation, and follow-up for individuals needing Exceptional Durable Medical Equipment (EDME) in accordance with OLTL requirements. Provide Preadmission Screening and Resident Review (PASRR) determination explanations for individuals with Level II PASRRs as referred by OLTL. Provide education and guidance related to SS/NHT programs to participants, nursing facilities, and community partners as appropriate. Establish and maintain positive working relationships with participants, families, supports coordinators, providers, nursing facility staff, community organizations, and other stakeholders to facilitate service delivery and positive outcomes. Resolve participant, provider, and stakeholder concerns through effective communication, problem-solving, and appropriate utilization of available resources. Manage assigned workload and scheduling responsibilities to ensure timely completion of assessments, transition activities, documentation, and follow-up activities in accordance with contractual requirements. Maintain accurate, timely, and compliant documentation, ensuring adherence to all contractual requirements, regulatory standards, and organizational policies, including HIPAA Privacy and Security requirements. Remain current on applicable OLTL, ODP, and other regulatory requirements, program updates, and best practices impacting service delivery. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.
Required Qualifications Bachelor’s degree in Human Services, Social Work, Psychology or a related field. A minimum of 3-5 years of experience working directly with individuals requiring long-term services and supports (LTSS).
Extensive experience working with the ID/A and geriatric populations. Strong familiarity with ODP waiver programs and OLTL services and supports. Preferred knowledge and experience working with nursing facilities, service providers and other stakeholders. Demonstrated problem-solving skills for complex issues and application of knowledge to process improvement and ensure issue resolution. Proven ability to conduct assessments and engage participants effectively through in-person, telephonic, and virtual platforms. Professional demeanor with strong interviewing, communication and relationship-building skills, including the ability to engage effectively with diverse audiences in both individual and group settings. Proficient in developing written summaries, participant documentation, and stakeholder communications while ensuring accuracy and compliance with program requirements. Intermediate proficiency in Microsoft Office products. Strong organizational and time management skills. Ability to work independently, prioritize tasks, manage workload, and meet tight deadlines in a fast-paced environment. Bilingual proficiency in English/Spanish is a plus. Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.
Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Experience in Lieu of Degree For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree. Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Visit us at https://careers.acentra.com/jobs EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Compensation The pay range for this position is listed below. “Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”
Up to USD $55,680.00/Yr.
Candidates must hold a bachelor's degree in a human services field or possess equivalent professional experience. A minimum of 3-5 years of experience working with individuals requiring long-term services and supports is required.