Transition Coordinator

At Cardinal Home Services we value every person on our team - supporting them both on and off the job. Together, we are a powerful crew: we hold each other accountable, step in to help wherever we can, and share plenty of laughs (and hugs) along the way. We consider our workplace culture and relationships just as important as the work we do. Read more about the job we are hiring for, and if you're interested in joining a team like ours and have the skills necessary to be a change-maker, send your cover letter and resume today! The perfect candidate would start just after the New Year.

Transition Coordinator is a professional who helps eligible individuals move from a qualified institution (such as a nursing home or hospital) back to their own home in the community. Their core role is to coordinate all necessary activities, services, and support to ensure a safe and successful transition.

Key Roles and Duties: The transition coordinator's responsibilities involve a person-centered planning process, extensive coordination, and practical assistance:

• Person-Centered Planning: The coordinator leads the development of an individualized "Transition Planning Tool" (DHS-6759J) that identifies the person's preferences, needs, and goals for living in the community. This includes developing a risk mitigation and emergency backup plan.
• Service Coordination: They help the person gain access to a wide range of services and support, including medical, social, educational, financial, and housing resources. This involves coordinating with community providers, discharge planners, and community case managers.
• Housing and Home Setup: A major duty is to locate affordable and qualified housing options. Once a residence is found, they coordinate details to set up the new home, including arranging for pre-transition cleaning, pantry stocking, delivery of medical equipment, and essential furnishings.
• Financial and Benefit Assistance: They assist individuals in obtaining necessary documentation and applying for essential benefits like Medical Assistance (MA), Social Security income, and funds for rent/utility deposits or moving expenses.
• Logistics and Day-of Move Support: The coordinator arranges transportation for housing searches and the actual day of the move. They are present on discharge day to ensure medications and required services are in place for an orderly transition.
• Documentation and Communication: They maintain detailed documentation, including informed consent forms and communication forms, and submit necessary information to the Minnesota Department of Human Services (DHS) to assure the residence is qualified.
• Post-Transition Follow-up: After the move, they help ensure a smooth transition to the community case manager who will manage ongoing support needs.

In essence, the transition coordinator acts as a single point of contact to guide and support an individual through every step of moving from an institution to independent community living

Education and Experience:

• Preferred: Bachelor’s degree in Social Work, Psychology, Sociology, Human Services, or a related field.
• Alternatively: A two-year degree in Human Services plus at least two years of relevant experience in mental health, social work, case management, or housing.
• Experience Substitution: Equivalent hands-on experience in case management, mental health, or human services may be considered in lieu of a bachelor’s degree.

Required certifications and checks

• Background check: Must pass a criminal background check administered by the Department of Human Services (DHS).
• Driver's license: A valid driver's license and proof of car insurance are required.

Pay: $21.00 - $24.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Paid training
• Parental leave
• Vision insurance

Work Location: In person