State of OregonTransition Coordinator (began position as APS/Transition Intern)
Sep. 2014 - Aug. 2016Hillsboro, OR•Transitioned Medicaid clients from nursing facilities into appropriate community-based care settings
•Educated patients and families about Medicaid transition services
•Coordinated general administrative tasks such as ordering durable medical equipment, creating purchase orders, and updating list a area providers and vacancies
•Followed clients for up to 90 days post transition
•Completed holistic assessments of client’s needs per Oregon Administrative Rule (OAR) requirements
•Provided assessment information to potential providers
•Provided Pre-Admission and Resident Review screenings to area hospitals and nursing facilities
•Collaborated with the long-term case management team on problem-solving transition issues
•Referred clients, families, and providers to community partners and information: STEPS, behavioral supports, movers, homecare worker eligibility
•Collaborated with Adult Protective Services (APS) workers to identify referrals that did not rise to the level of abuse
•Participated in IDT meetings (APS, police, Elder safe) to increase streamlined communication