Money Follows the Person (MFP) Transition Coordinator/IL Specialist

POSITION SUMMARY

The Money Follows the Person (MFP) Transition Coordinator/IL Specialist provides individualized, person-centered transition services to people with disabilities who are preparing to move from institutional settings into the community. Core responsibilities include completing intakes, transition assessments/plans, developing safety plans, coordinating resources & supports, and providing information & referrals that promote independence, choice, and self-determination.

The MFP Transition Coordinator/IL Specialist collaborates with consumers, guardians, nursing facilities, service providers, state program representatives, and other members of the transition-planning team to ensure that housing, transportation, medications, personal assistance, and other essential supports are in place before transition. This position also maintains accurate and timely consumer records, documents required activities in DCIL and MFP data-management systems, completes required reports, and provides appropriate follow-up to support a successful transition to community living.

The MFP Transition Coordinator/IL Specialist requires knowledge of cross-disabilities, effective communication, and strong organizational/interpersonal skills. The position must uphold confidentiality and embody the Independent Living philosophy, including an understanding of its history and the Americans with Disabilities Act (ADA), while supporting each consumer's right to make informed choices and direct their own services and goals.

QUALIFICATIONS

1. Bachelor's degree in Social Work, Human Services, or a related field. Equivalent life and/or work experience may be considered in lieu of a degree.

2. Two years of experience working with individuals with disabilities.

3. Effective communication, organizational, and interpersonal skills.

4. Ability to maintain accurate records and manage multiple priorities.

5. Familiarity with the Independent Living philosophy and disability rights movement.

6. Knowledge of Medicaid, Medicare, Social Security programs, and community resources preferred.

ESSENTIAL DUTIES & RESPONSIBILITIES

1. Develop and maintain a thorough understanding of DCIL's mission, programs, services, policies, history, and the Independent Living philosophy, as well as applicable MFP requirements, guidance, operational protocols, and documentation standards.

2. Receive and review MFP referrals; determine program eligibility; gather pertinent background information; complete required intake documentation; and make timely initial contact with consumers, guardians, and referral sources.

3. Explain DCIL and MFP services, program requirements, participant rights, available choices, and the transition process in an understandable and person-centered manner that supports informed decision-making.

4. Assess the involvement and authority of a consumer's guardian or other legal representative, and document all related communication and activities.

5. Complete comprehensive Transition Assessments that identify consumer strengths, preferences, goals, risks, resources, support needs, and barriers to community living.

6. Work directly with the consumer and MFP team to develop, implement, monitor, and update a person-centered Transition Plan based on the consumer's choices, needs, and desired community-living outcomes.

7. Develop and maintain required Risk Assessments, Safety Plans, emergency plans, and 24-hour backup plans; promptly address identified health, safety, or service concerns with the consumer and appropriate team members.

8. Coordinate transition planning meetings and maintain effective communication among consumers, families, guardians, nursing facilities, HCBS representatives, service providers, housing resources, and other involved partners.

9. Assist consumers in identifying, applying for, and coordinating the services and supports needed for community living, including housing, HCBS, personal assistance, transportation, medications, medical equipment, food, utilities, furnishings, accessibility needs, and other essential resources.

10. Verify that necessary services, supports, authorizations, equipment, supplies, and living arrangements are in place before discharge and coordinate with the transition team regarding anticipated and confirmed transition dates.

11. Assist with requests for allowable MFP transition services, supplemental services, temporary rental assistance, household items, accessibility supports, and other approved expenditures; obtain required documentation, approvals, estimates, receipts, and follow-up information in accordance with program and agency requirements.

12. Support the consumer during the discharge and move into the community, including coordination with the nursing facility, service providers, housing contacts, and other members of the transition team as needed.

13. Provide appropriate post-transition follow-up to monitor service continuity, progress toward goals, unmet needs, health and safety concerns, and risks of re-institutionalization; coordinate timely problem solving and referrals when concerns arise.

14. Establish/maintain accurate consumer service records, including referrals, assessments, plans, authorizations, supporting documents, contacts, services, & follow-up.

15. Document consumer contacts and transition activities in CIL Suite, Therap, and other required systems within established timeframes, including weekly documentation when required by the MFP Operational Protocol or agency procedure.

16. Complete and submit accurate monthly, quarterly, annual, and other required reports, statistics, forms, and program documentation within established deadlines.

17. Maintain cooperative and professional working relationships with consumers, guardians, nursing facilities, state program representatives, community agencies, housing providers, and service providers involved in the transition process.

18. Immediately communicate significant transition barriers, documentation concerns, health or safety issues, service interruptions, re-institutionalization risks, and other urgent matters to the MFP/TDPP Program Director and appropriate program partners.

19. Attend required transition meetings, territory meetings, staffings, in-services, trainings, and other meetings requested by the MFP/TDPP Program Director or MFP Administrator.

20. Travel throughout DCIL's service-delivery area as needed to meet with consumers, participate in transition planning, coordinate services, attend meetings, and support community transitions.

21. Perform other reasonable duties as assigned by the MFP/TDPP Program Director or Executive Director.

OTHER JOB FUNCTIONS

1. Participate in scheduled supervision, staff meetings, case consultation, and agency planning activities.

2. Participate in in-service training and professional-development opportunities to maintain and strengthen knowledge and skills.

3. Maintain strict consumer confidentiality and safeguard consumer and agency information in accordance with applicable laws, contracts, and DCIL policies.

4. Comply with all DCIL policies, procedures, documentation standards, and professional expectations.

5. Maintain current knowledge of disability services, community resources, housing options, benefits, service providers, and transition supports available throughout the service-delivery area.

6. Participate in annual performance evaluations and contribute to the planning and development of DCIL's annual work plan.

7. Maintain proficiency with Microsoft Office and the ability to learn and use CIL Suite, Therap, and other required program or reporting systems.

8. Represent DCIL professionally and respectfully in all communication, meetings, community settings, and interactions with consumers and partner agencies.

SUPERVISORY RELATIONSHIPS

The MFP/TDP Program Director will supervise the person filling this position.

SUPERVISORY AUTHORITY

This position has no supervisory duties.

SPECIAL REQUIREMENTS

1. Knowledge of physical, cognitive, sensory, developmental, and mental health disabilities and the ability to provide respectful, person-centered, cross-disability services.

2. Understanding of the Independent Living philosophy, disability rights movement, community integration, consumer choice and control, self-determination, and the Americans with Disabilities Act (ADA).

3. Ability to evaluate daily living skills, identify transition barriers and risks, coordinate appropriate supports, and collaborate with consumers to establish meaningful and achievable community-living goals.

4. Strong organizational, planning, problem-solving, time-management, oral and written communication, and interpersonal skills, with the ability to manage multiple consumers, priorities, deadlines, and documentation requirements.

5. Ability to exercise diplomacy, tact, sound judgment, and professional boundaries; work effectively as a team member; and remain motivated, self-directed, and able to work independently.

6. Ability to communicate effectively and maintain cooperative working relationships with consumers, families, guardians, facility staff, state partners, service providers, housing professionals, and community organizations.

7. Ability to maintain strict confidentiality and appropriately handle sensitive health, financial, legal, and program information.

8. Ability to coordinate appropriate follow-up services after transition and after consumers achieve established goals to support service continuity and continued community living.

SPECIAL CONDITIONS

1. Occasional work outside of standard business hours may be required to meet consumer and program needs.

2. A 90 day to 180 day probationary period may apply.

3. The position is contingent upon funding.

4. Employment is contingent upon successful completion of an initial criminal-record/background check and any ongoing or additional screening required by law, contract, or agency policy.

5. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties of this position.

6. DCIL is a fragrance-free work environment.

7. Duties are performed in a variety of settings, including the office, community locations, consumer homes, nursing facilities, and other institutional or residential settings throughout the service area.

8. The position requires effective communication and may involve sitting, standing, walking, reaching, bending, lifting or carrying routine work materials, and other movement necessary to perform assigned duties.

9. Frequent travel within the service-delivery area is required.

Job Type: Full-time

Pay: From $21.66 per hour

Expected hours: 40.0 per week

Benefits:

• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Education:

• Bachelor's (Preferred)

Experience:

• working with individuals with disabilities: 2 years (Preferred)

Language:

• English (Required)

License/Certification:

• Driver's License (Required)

Ability to Commute:

• Bismarck, ND 58501 (Required)

Work Location: In person

Salary : $22