Job Overview:

Provides leadership and directs and develops the strategies and activities for the Care Transitions teams to optimize their efforts, assure effectiveness, and enhance efficiency to positively impact clients’ experiences. Coordinates and modifies programs within Care Transitions working with MCOs, hospitals and internally. Participates in developing the program initiatives and offers a forward-thinking approach.

Supervision:

Reports to the Chief Program Officer

Duties/Responsibilities:

• Oversees the implementation and ongoing work of the coaches for the Care Transitions programs for different community partners;
• Directs the Care Transitions activities including promoting team participation and person-centered practices to optimize workloads and adapt to the changing needs of the programs.
• Prepares and reports as needed on the outcomes of the work along with analyzing the data for possible adjustments in practice.
• Provides presentations on the CT program to key stakeholders and potential stakeholders
• Monitors and uses needed data systems including PeerPlace and MCO Database to capture needed information.
• Provides regular reports and documentation on activities for MCO billing purposes.
• Monitors assigned cases and implements needed training of Care Transitions’ Coaches to assure quality service and accuracy in documentation;
• Collaborates with the Chief of Programs on profit and non-profit contracts to strategize approaches and needed interventions to provide and sustain the Care Transitions programs, or other related services.
• Maintains knowledge of current developments on the various aspects of care transitions for clients through involvement with other community partners in developing programs and current publications from other health care organizations.
• Promotes the Care Transitions Program and collaborates directly with other community partners.
• Assists with recruiting, training and supervision of Care Transitions’ staff.
• Supports outreach efforts for the Agency with the intent of connecting to other community partners to further opportunities for the program to serve additional clients.
• Performs Care Transitions Interventions
• Participates in advocacy efforts to support and address the diverse needs of the communities we serve.
• Seeks to develop opportunities for community volunteers to engage with appropriate aspects of their department and or program, with support from Volunteer Services Staff.

Knowledge, Skills, and Abilities:

• Knowledge of the theories, principles, and practices of public human service organizations and public assistance programs; knowledge of current social, economic, and health problems and of human behavior and social functioning; ability to analyze facts and to exercise sound judgment; ability to plan, assign, and supervise the work of others; ability to plan and organize work, and to understand and interpret laws, policies, and regulations; ability to communicate and establish effective working relationships with co-workers, other professional and technical staff, social agencies, and the general public; ability to prepare reports and maintain digital records; ability to communicate complex ideas effectively, verbally and in writing; ability to work effectively in an inter-disciplinary team setting; ability to develop and administer a program budget effectively.
  
  

Education and Experience:

Requires a Bachelor’s Degree from an accredited college or university with major course work in social work, human service, gerontology, psychology, health or a related field with preference for master’s degree in health and human services. Prefer 5 years’ experience in social work or human services. Experience working with older individuals, caregivers and knowledge of aging issues required. Demonstrated ability to supervise the work of others. Skilled in the use of Microsoft Office products. MCO experience preferred.

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer.
• Prolonged periods of sitting behind a vehicle for travel time within our planning district.
• Must be able to lift up to 15 pounds at times.

The Span Center is a trauma-informed, person-centered agency dedicated to fostering a safe and supporting environment for both our employees and the communities we serve.

The Span Center prohibits discrimination on the basis of race, color, religion, national origin, sex, pregnancy, childbirth or related medical conditions, age, marital status, disability, sexual orientation, gender identity, genetics, political affiliation, or military status in the recruitment, selection, and hiring of its workforce.