Reports To:       State Home Care Director

 Basic Function:    Direct supervision of the day-to-day requirements of Community Transition Liaison and case management staff.  Assists the State Home Care Director in the management and administration of the program.

Responsibilities:

1.   Primary contact for the Community Transition Liaison Program (CTLP) with AGE and other program partners.
2.  Provides supervision, direction, and oversight to the CTLP team and monitors the Community Transition Liaison's assigned responsibilities and activities.
3.   Provides oversight of CTLP nursing facility transition activities, including ensuring that assigned nursing facilities are visited weekly and that the Community Transition Liaison maintains regular communication and collaboration with nursing facility nursing and social work staff.
4.  Ensures the Community transition liaison participates in discharge planning meetings, as appropriate, and assists consumers with transition planning and coordination of community-based services.
5. Monitors the Community Transition Liaison team's collection and completion of required documentation, applications, and referrals for housing, public benefits, and other community resources needed to support successful transitions from nursing facilities.
6.  Ensures that program referrals are completed and followed up on in a timely manner and that barriers to discharge or community placement are identified and addressed appropriately.
7.  Collaborates regularly with the Fiscal Department regarding tracking for the CTLP Team Expense Account and Money Follows the Person Demonstration reports.
8.  Reviews cases to evaluate service plans, service delivery, eligibility, and compliance with program requirements and specialized program guidelines.
9.  Approves applicants' need for services and approves service plans and levels of care within authorized limits and program guidelines.
10.  Reviews and approves openings and Annual Reassessments and ensures that required changes are accurately and timely updated in the computer system and consumer file.
11. Conducts field visits with each Care Manager two times per year to observe performance, provide feedback, and support ongoing professional development.
12.  Ensures that staff maintain appropriate and timely contact with consumers and follow program requirements for ongoing case management and transition services.
13.  Participates in interviews and makes recommendations to the State Home Care Director regarding the hiring of personnel reporting directly to the Supervisor.
14. Assigns, directs, and oversees the work of all staff under his/her direct supervision through regularly scheduled supervision sessions.
15.   Maintains an open-door policy and is available to Care Managers and CTLP staff for guidance, consultation, and support.
16.  Ensures that assigned duties are completed accurately, timely, and in accordance with program specifications, policies, and procedures.
17. Involves staff in the development, clarification, and continued improvement of operational procedures and policies by soliciting comments, suggestions, and feedback.
18.  Reviews “At Risk” consumers at quarterly intervals and ensures that appropriate follow-up is completed.
19. Participates in and makes recommendations during Interdisciplinary Case Review Meetings for assigned consumers.
20. Fulfills executive and supervisory responsibilities as specified in the Supervisor Performance Evaluation.
21.  Performs miscellaneous duties and assignments as directed by management.