With general supervision, provide advocacy, short-term counseling, support, linkage, and coordination of services for individuals transitioning out of facilities to the community. Conduct intake assessments, social work evaluations, and develop 90 day initial individual service plans to prepare for long-term services. Participate in team meetings with participants and their proposed service providers, and advocate for their rights and implementation of needed and desired services.
The main goal is to assist the participants in maintaining and obtaining services that will assist them to live in the most integrated setting possible, within the community.
- As a representative of CDR, be committed in all that you do to support, perpetuate, and model the CDR Mission.
- Provide potential participants with HCBS options.
- Build and maintain knowledge of HCBS in your region.
- Participate in discharge planning.
- Coordinate with RRDC’s, OPWDD State Operations Office and Regional Office’s Front Door, and MLTC/MCO’s.
- Assess and develop person-centered transition service plans, which may include securing qualified housing the participant.
- Coordinate home and community services during transition period.
- Ensure continuation of service after the transition period.
- Maintain files that are current and in compliance with the CDRs standards and State DOH regulations.
- Meet all documentation timeline and maintain quality of services.
- Participate in trainings at the discretion of the Supervisor and strives for professional development and to increase their knowledge base related to participant population.
- Review program updates as administered, and implement all changes, regulatory and otherwise.
- Link the participants with an appropriate service provider who can assist them in implementing the appropriate portion of their service plan.
- Assist the participant in securing a community housing that meets their individual welfare and safety needs.
- Review the outcomes of the participant’s service plan and advocate for the needs and changes in the services as necessary in combination with the participants needs and desired outcomes.
- Attend appointments and meetings as necessary.
- Other duties as assigned or required.
A degree in one of the following areas: Occupational Therapist, Registered Physical Therapist, Speech-Language Pathologist, Registered Professional Nurse, Certified Rehabilitation Counselor, Master of Social Work, Master of Psychology. Accompanied by a Minimum of one (1) year experience providing service coordination for individuals with disabilities and knowledge about community resources; A Bachelor’s Degree in a human service related field and two (2) years of experience providing service coordination to individuals with disabilities, and knowledge about community resources; A Bachelor’s Degree and specific experience related to transitioning individuals from nursing facilities to community living.
Possess a basic knowledge and understanding of public welfare, Social Security benefits and entitlements. General knowledge and understanding of developmental disabilities, traumatic brain injury, and mental illness. Have knowledge and understanding of the challenges facing individuals who have developmental and cognitive disabilities, and choose to live independently with in the region. Understanding of Independent Living philosophy. Basic knowledge of the ADA, and a desire to learn more about the public laws that uphold the civil rights of disabled individuals. Knowledge of community services available to the citizens in the region.
Essential Functions/Physical Requirements:
The Job Duties are representative of the essential functions of the position. The physical requirements for this position are those typically present in normal office environment conditions. Operational flexibility is required to meet sudden and unpredictable needs. Reliable transportation is necessary as there may be local day business travel required of this position.
Center for Disability Rights is an EEO employer - M/F/Vets/Disabled