Transition/Custodial Prevention Specialist
Core
Field specialist creating personalized care plans and coordinating Long Term Services and Support (LTSS) for members in Kane and DeKalb counties to promote independence and health outcomes.
Role type
Senior IC case management specialist (LTSS)
Builds
Individual Service Plans and care coordination for members receiving Home and Community-Based Services (HCBS)
Domain
Healthcare / Social Services / Long-Term Care
Required skills
Case management, care planning, resource navigation, psychosocial support, interdisciplinary collaboration, Medicaid eligibility education, electronic medical records proficiency
Preferred skills
Licensed Professional Counselor (LPC), Licensed Social Worker (LSW), or Registered Nurse (RN); Nursing home diversion experience; Waiver Program experience; Bilingual (English/Spanish, Arabic, Vietnamese, Amharic, Urdu)
Technologies
Electronic medical records, state assessment portals
Responsibilities
Assess member goals, needs, and barriers; connect members with quality services and community partners; advocate for member care in nursing facilities; develop and modify Individual Service Plans; facilitate interactions with interdisciplinary care teams; educate members on maintaining Medicaid eligibility; assist with entry of annual Level of Care assessments.
Seniority
Mid-level, hands-on IC