Diversion & Transition Case Manager

Diversion & Transition Case Manager - Salem, OR Job Tracking ID: 512378-873431 Job Location: Salem, OR Job Level: Mid Career (2+ years) Level of Education: BA/BS Job Type: Full-Time/Regular Date Updated: February 13, 2024 Years of Experience: 5 - 7 Years Starting Date: ASAP Job Description: We look for skilled employees who are passionate about our mission and values, and providing excellent customer service.
We value our employees and the people we serve and it shows! Our mission is to promote dignity, independence and health: honor choice & empower people.
Our Values are Service, Compassion, Integrity, Professionalism Recruitment #: 410-07-23 Closes: Open Until Filled Location: Salem, OR Salary Range: $4,391 per month, with excellent benefits (see below), Excellent Benefits: Medical/Dental 100% paid for employee and 90-98% for dependents, generous Paid-time off, Public Employee Retirement (PERS), Employee Assistance Plan, Long Term Disability, great culture.
General Description Performs Professional-level work in the provision of social services by helping consumers and/or families to prevent unnecessary placement in nursing facilities and facilitate transitions for those who can be better served in a lower level of care, such as in-home or a community-based setting.
Essential Functions Determine the need and appropriateness of Diversion and Transition Services Develop transition plan Implement, monitor and adjust transition plan Transition case to ongoing Case Manager Support and promote Diversion and Transition services Promote Agency services and Aging and Disability Resources Connection (ADRC) concept Facilitate confidence in Diversion and Transition Case Manager, and therefore the Agency and programs Protect consumers and reduce Agency risk Provide excellent customer service in a professional manner 1.
Determine the need and appropriateness of Diversion and Transition Services Conduct consumer assessments to identify need and determine eligibility for services Carry Nursing Facility caseload to better transition consumers to lower level of care as appropriate Work directly with hospitals on new referrals for long term care services eligibility and placement Gather information through interviews, observations, other staff, hospital discharge planners, and other resources Consider consumer’s preferences, goals, safety, resources, etc.
in determining Assessments and placements Complete assessment tool Assist consumers in Long Term Care Facilities which are closing and no longer operate under Medicaid to find alternate care Carry enhanced care facility cases and manage the complexities of them Carry specific need contract cases and manage the complexities of them 2.
Develop transition plan Analyze information gathered during assessment.
Determine the type of services necessary and the best type of in-home or community-based setting Work with the consumer and/or family to accept plan developed 3.
Implement, monitor, and adjust transition plan Coordinate the delivery of services identified Arrange care setting, medical supplies, equipment, transportation, etc.
Provide assistance to alleviate serious environmental, medical, or social problems Work with other partners to assist in effective transition Evaluate the meeting of consumer needs through required monitoring for 30-90 days on case transfers and specialized contracts placements.
This will include monitoring by phone, and in-person contact.
Evaluate delivery and quality of services Facilitate provider payment Adjust plan according to changing care needs of consumer, handling issues as they arise Track work in Diversion and Transition database 4.
Transition case to ongoing Case Manager Determine success and stability of transition plan Identify the appropriate receiving Case Manager Provide case management information through case notes/files Communicate with all individuals involved to ensure a smooth transition 5.
Support and promote Diversion and Transition services Communicate with appropriate staff and partners Provide education and outreach on Diversion and Transition services for Agency staff, community partners, and the public 6.
Promote Agency services and ADRC concept Educate self of Agency programs and services and other resources available for populations served, including using ADRC of Oregon online resource directory Understand current issues and solutions for seniors and people with disabilities Establish cooperative relationships with other human service agencies and organizations 7.
Facilitate confidence in Diversion and Transition Case Manager, and therefore the Agency and programs Embrace and exhibit the Agency Mission, Vision, and Core Values Use a person-centered approach Provide excellent customer service Meet the needs of consumers Follow through and meeting deadlines Interact with others in a respectful and culturally appropriate way Work effectively with a wide variety of individuals Maintain skills and knowledge to perform duties Provide suggestions for improvement 8.
Protect consumers and reduce Agency risk Follow policies, regulations and requirements of project and Agency; document plan and progress as required.
Provide documentation as set forth by Federal, State, funding regulations, and Agency policy Serve as a Mandatory Reporter of suspected abuse of vulnerable populations as required by policy and regulation Maintain and sharing information according to privacy regulations 9.
Provide excellent service in a professional manner Apply the required knowledge and skills and exhibit critical thinking and problem solving Exhibit good decision making, problem solving and work habits Meet quality standards in accuracy, judgment, timeliness and following policy and procedure Exhibit good work habits, including organizational skills, regular attendance, working independently, seeking and offering assistance when needed Follow policies and procedures Work independently, but seek and offer assistance when needed Exhibit technology skills related to the work needing to be done, (word processing, spreadsheets, database, internet research, mail, IM, phones, copiers, assessment programs like as CAPS, Oregon ACCESS, etc.
) Exhibit a positive attitude towards consumers, co-workers and others Job-specific skills and knowledge Experience working with seniors and people with disabilities and the issues experienced by these populations (social, physical, care, etc.
) Knowledge of transition techniques, services, resources available, and service eligibility requirements Knowledge of the Case Manager position, processes and responsibilities Ability to interview others, observe, and assess situations accurately Knowledge of family dynamics Ability to translate observations and assessments to care plan Knowledge of long term care settings and appropriateness for consumer needs Knowledge of federal and state laws and regulations regarding long term care placements Knowledge of components of services, supplies, equipment, and transportation to ensure services are appropriate to meet needs and delivered effectively Ability to respond to issues and problem solve solutions Knowledge of and experience with case management and case management assessment tools Ability to learn specific tools used by Agency Ability to explain services and concepts in easily understood terms Ability to develop community relationships Ability to identify outreach opportunities Presentation skills and experience Understanding of ADRC Ability to source information regarding available services Ability to build relationships and network Ability to be a self-starter and be adaptable to change Ability to be a team-player Ability to set goals based on Agency expectations and develop a plan to meet and/or exceed goal expectations Continuous learning about issues and solutions for populations served Ability to learn and apply policies, regulations, requirements, rules around mandatory reporting, privacy, and confidentiality Knowledge of Family Caregiver Support Program, and general knowledge of the dynamics of care giving and resources available General Skills Needed to Meet Agency Expectations Must be able and willing to perform the following: Support the agency mission and exemplify its core values—integrity, professionalism, service, and compassion Serve as a mandatory reporter of suspected cases of neglect, exploitation, and abuse of vulnerable populations as required by policy and regulation, and make the appropriate referral to a responsible agency such as Child or Adult Protective Services Units Interact and work effectively with others in a team to deliver services to consumers Demonstrate good interpersonal communication skills through written, verbal, and nonverbal communication Use sound organizational skills to meet deadlines in a timely, accurate, and efficient manner Speak, read, write, and understand English and follow verbal and written instruction Perform other work as assigned by the supervisor Experience and Skills: Minimum Qualifications - Experience and Education A qualified applicant will have a minimum of six (6) years of equivalent combination of education and/or experience which demonstrates the knowledge, skills and abilities required.
The following qualifications meeting the minimum requirements will be considered: Bachelors degree in social sciences or any related field Work or volunteer experience working directly with consumers in social service type settings.
Experience can be substituted for education.
Any combination of related education and relevant work experience equaling at least 6 years.
(For Bilingual positions only) Successful completion of a language proficiency test.
While not required, experience working with seniors or adults with disabilities or vulnerable populations is a plus.
Work Environment and Physical Demands Case managers work both in an office environment and in the community.
They: Use a computer, telephone, and other office equipment Need to tolerate and be able to work where the noise level is that of a typical office Travel to consumers’ homes or care settings to meet with consumers (in an agency or personal vehicle) Work on site at a social services entity and health care facility May encounter frequent interruptions throughout the work day Are regularly required to sit, talk, or hear Use repetitive hand motions Must be able to handle objects and sustain a sense of touch Must be able to stand, walk, reach, and bend Must be able to lift up to 20 pounds Contact with the public in homes, facilities, or office environments may risk exposure to people with contagious diseases or irrational/hostile behavior and contact with domestic animals.
The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Other Requirements To be successful, candidates must: Secure and maintain a valid Oregon driver’s license or have an acceptable alternative means of transportation Attend work regularly to meet the demands of this job and to provide necessary services Complete and pass a criminal background check Supervisory Responsibilities None.
Classification: Bilingual Diversion and Transition Case Manager Position Number: Varies Salary Range: R22 FLSA Status: Non-exempt Unit: Diversion and Transition Location: McMinnville Reports to: RN Program Manager Union Status: Represented Last revision: March 9, 2023 This job description is a general guide for the job to be performed and does not cover everything.
Employees may be required to perform other duties, including covering for, and in, other offices.
Employees are expected to follow and perform other job-related duties requested by their manager.
Reasonable accommodations will be made as needed.
Job descriptions are subject to change.