[Remote] Transition Care Coordinator (Mid State)

Note: The job is a remote job and is open to candidates in USA. Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. They are seeking a Transition Care Coordinator to provide care coordination, treatment planning, assessment, and referral services for individuals with complex health needs. The role involves collaborating with a team to ensure successful discharge and transition planning for clients.

Responsibilities

• Work collaboratively with licensed Clinicians, Registered Nurses, and Peer Support Specialists to ensure successful discharge/transition planning/post transition monitoring
• Provide care coordination/care management to assigned TCL individuals who may have identified needs with behavioral health, physical health, co-occurring, co-morbid or multi-morbid conditions
• Assess member’s needs who have transitioned into supportive housing to determine if additional support and services are needed for continued independent living
• Complete assessments as needed
• Ensure timely and accurate documentation of all planning and coordination efforts in multiple software platforms and State database systems

Skills

• Master's degree in a human services field or licensure as an RN and one (1) year of relevant experience working directly with individuals with SED or SMI; OR
• Bachelor's degree in a human services field or licensure as an RN and three (3) years of relevant experience working directly with individuals with SED or SMI
• Must have a valid driver's license
• Must reside within Trillium's Mid State Region, which includes the following counties: Anson, Guilford, Montgomery, Randolph, and Richmond
• Must be able to travel within catchment as required
• Experience and knowledge of peer support and experience working with individuals who are certified peer support specialists

Benefits

• Health Insurance with no premium for employee coverage
• Flexible Spending Accounts
• 24 days of Paid Time Off (PTO) plus 12 paid holidays in your first year
• NC Local Government Retirement Pension (defined-benefit plan)
• 401k with 5% employer match and immediate vesting
• Public Service Loan Forgiveness (PSLF) qualifying employer
• Quarterly stipend for remote work supplies

Company Overview