Community Transition Liaison

OCES is growing!

We are expanding to 11 more towns covering the south shore area, including Quincy, Braintree, Weymouth, etc.

OCES supports older adults and individuals with disabilities by providing vital information and coordination of services. By promoting healthy, safe living for our consumers, we hope to allow them to stay active and engaged in their lives and in their own communities for as long as possible.

Our mission: Through the talents of an experienced and diverse workforce, OCES supports the independence and dignity of older adults and individuals with disabilities by providing essential information and services that promote healthy, safe living which positively impacts our community.

We are seeking a Community Transition Liaison to facilitate successful discharge activities and other support activities for assigned consumers focusing on the transition from nursing facilities (NF) to community. The Community Transition Liaison is responsible for facilitating successful discharge activities and other support activities for assigned consumers focusing on the transition from nursing facilities (NF) to community.

What you will do:

Acts as onsite point of contact for residents, families, health care proxy (HCP)and NF staff
related to transitions from NF to community
Visits with residents to increase awareness of service and introduce transition to the community
as a potential option
Participates in resident, family and/or HCP conversations to inform options and transition
planning
Completes the directional screening tool to determine potential appropriateness for referrals to
HCBS Waivers and other programs to support the transition to the community and meet the
consumer's needs once in the community setting
Facilitates person-centered planning and needs assessment
Begins the process of gathering necessary documentation and identification needed for housing
applications and other public benefits
Completes referrals to other programs and follows-up on referrals to ensure timely transition
Participates in Interdisciplinary Discharge Planning (IDP) meetings and facilitates communication
among the consumer, family members and community agencies.
Participates and facilitates in discharge planning meetings with the consumer, family, nursing
facility staff and other agencies that will support the consumer in the community upon
discharge
Coordinates with state programs and teams
Maintaining case records in compliance with regulations, standards, and protocols
Maintaining knowledge of current OCES policies and standards, and funding source regulations
Other duties as assigned.

What you will bring:

Bachelor's degree in nursing, social work, human services, or related field
Current Social Work License preferred
Must possess knowledge of long-term care, case management, discharge planning, community
resources, programs, and benefits to help support an individual's transition from an institutional
to a community setting
Two years of experience in the social services field including a minimum of one year of experience
with transition support activities

Excellent verbal and written communication skills.
Excellent interpersonal and conflict resolution skills.
Excellent organizational skills and attention to detail.
Strong analytical and problem-solving skills.
Strong supervisory and leadership skills.
Proficient with Microsoft Office Suite or related software

What you will get:

• Ability to work with an enthusiastic team of like-minded individuals.


• Opportunity to develop professionally in your chosen career.


• Great work/life balance: 35-hour work week with some flexibility; no weekends


• Exceptional benefits: generous paid time off policies; company paid LTD and life insurances; 401K plan.

APPLY TODAY!

OCES is an open, welcoming organization that respects our diversity. We encourage all qualified people to apply!