Employment

The basic function of the Community Transition Liaison and State Home Care Administrative Assistant, (CTL/SHC Admin) is to perform administrative tasks supporting the CTL and SHC Programs. 

Responsibilities:

• Supports the Community Transition Liaison to operate at the top of their role and responsibility.
• Gathers documentation needed to assist the consumer in applying for public benefits and housing applications.
• Conducts clerical duties to support State Home Care Program to meet the requirements set forth by EOEA. 
• Maintains current electronic and paper records of all data for consumers and the department.
• Ability to work in Microsoft Teams and manage Share point data and file attachments in SAMS. Completes all scanning, uploading of files for the department, making sure all files are up to date.  Manages mass health report (Elira).
• Assists in the orientation/training of in-house procedures for new department staff.                          
• Assists with setting up meetings, trainings, etc. as needed.
• Monitor Patient Ping and follow up as needed for hospitalizations/discharges.
• Manage monthly reports in SAMS to ensure compliance with EOEA regulations.
• Review expiring care plans monthly and forward to ensure continuation of services as authorized.
• As needed, accompanies the Liaison on nursing facility visits.
• Provides back-up for receptionist desk and provider specialist as scheduled.                    
• Provides input regarding any needs of the program or changes that could be beneficial.
• Performs other duties as directed.

Essential Functions/Qualifications:

• High School diploma or GED with one year of related work experience and/or interest in working with nursing facility residents including older adults or persons with disabilities who are transitioning from an institution to a community setting.
• Regular and reliable attendance.
• Organizational and time management skills.
• Communication Skills with consumers, employees, physicians, family members, providers (telephone, email or in person, as needed).
• Written communication skills.
• Meet deadlines in a timely fashion.
• Problem solving skills.
• Works as a member of a team and independently.
• Accurate record keeping skills.
• Maintain Confidentiality.
• Attention to detail.
• General office procedures.
• Knowledge of MassHealth programs and community supports.
• Computer Acuity.
• Software: Windows, Microsoft Office 365 package, Outlook
• Ability to be flexible and work in a fast-paced environment.

 Physical Demands:

• Computer access
• Must be able to sit for periods of time at computer.
• Constant bending, reaching, twisting, standing.

 Work Environment: 

Traditional office environment including work from home along with meeting consumers at their homes or in public places.

The basic function of the State Home Care – Care Manager, (SHC CM) is to assist older adults in obtaining services that will secure an independent lifestyle.  To identify gaps in services and advocate for services that will maximize independent functioning. To educate and promote awareness of community services. 

Responsibilities:

• Conduct an initial assessment of physical, social, environmental and emotional status to determine needs and eligibility requirements within EOEA time frame guidelines.          
• Develop service plan and supportive networks through contact with client, formal and informal supports, and consultation with supervisor.       
• Implement service plan by telephone immediately followed by authorization to provider agencies.
• Assist client to obtain and utilize other community services such as: VNA, housing, fuel assistance, council on aging, Medicaid, etc.   
• Monitor client’s needs and service plan on an ongoing basis.
• Participate and recommend clients for ICR meetings as needed.                                             
• Provide support and information to clients and those directly involved in client’s care. 
• Encourage self-advocacy.             
• Keep the files up to date, includes changes in services and observations.  The files should include copies of all correspondence with the client.
• Keep journal notes up to date, including summary of telephone contacts, service changes and calls concerning client.   
• Complete authorizations, notices of suspension, and termination and other related forms in a timely manner.                    
• Record statistical data. 
• Accurately complete monthly reports. 
• Verify client file information for the annual hand count for EOEA.                                         
• Update knowledge pertaining to gerontology and services for elders through courses, and in services.                       
• Participate in staff meetings to discuss home care and other related issues.                          
• Meet with supervisor on a regular basis.                                    
• To work with and monitor in-house programs and vendors.  Conduct ongoing client satisfaction and vendor observation visits and complete the appropriate corresponding forms.                   
• Perform miscellaneous duties and assignments as directed by immediate supervisor.

Essential Functions/Qualifications:

• Regular and reliable attendance.
• Bachelor’s degree in Social Work Human Services or related field preferred
• Organizational and time management skills.
• Communication Skills with consumers, physicians, family members, providers (telephone, email or in person, as needed).
• Communication skills with funders, state and federal agencies, ASAPs.
• Communications skills with employees.
• Cultural competency and the ability to provide informed advocacy.
• Knowledge of home and community-based service systems and how to access and arrange services (preferred).
• MassHealth programs (preferred).
• Public benefits.
• Familiarity with state-wide health care network (preferred).
• Written communication skills.
• Demonstrated analysis and problem-solving skills.
• Meet deadlines in a timely fashion.
• Able to develop and maintain positive effective relationships with providers, consumers, and the public.
• Problem solving skills.
• Works as a member of a team and independently.
• Motor vehicle.
• Valid Driver’s license; maintain minimum insurance liability on vehicle and complete motor vehicle driving record check.
• Accurate record keeping skills.
• Maintain Confidentiality.
• Attention to detail.
• General office procedures.
• Consumer Advocate.
• Computer Acuity.
• Software: Windows, Excel, Power Point, Outlook.
• Ability to be flexible and work in a fast-paced environment.
• Maintain caseload/production at program/department standards.

Physical Demands:

•  Computer access.
• Ability to traverse homes, yards and stairways.
• Must be able to sit for periods of time at computer or while driving.
• Must be able to carry files of up to 5 pounds and laptop.
• Occasional bending, reaching, twisting, standing and climbing.
• Frequent Standing and walking.

Work Environment:

Traditional office environment including work from home along with meeting consumers at their homes or in public places.

The basic function of the Community Transition Liaison, (CTL) is to promote, educate, identify, and assist nursing home residents with options related to transitioning into the community.

Responsibilities:

• Onsite point of contact for residents, families, skilled nursing facility (SNF) staff and all other parties involved with resident’s care for nursing facility transitions to the community.
• Visit assigned nursing facilities weekly, collaborate with nursing and other SNF professionals and attend discharge meetings as needed.
• Meet with residents to increase awareness of community supports and services and introduce transition as a potential option.
• Have knowledge of and work closely with community partners of State programs to maximize resources and eligibility for services.
• Identifies individuals appropriate for CTLP based on resident’s desire to transition to community living environment including use of PASRR portal to facilitate resident identification.
• Assist residents to determine the most appropriate supportive program and determine eligibility to ensure effective transition to the community.
• Assist with gathering all necessary documentation needed and completion of applications for housing and other public benefits.
• Complete and follow up on program referrals to ensure timely transition.
• Develop a service plan and supportive networks through contact with consumer, formal and informal supports, and consultation with supervisor.
• Manage the discharge process along with purchasing goods and services for transition.
• Assist and provide support to families and consumers.  Encourage self-advocacy. 
• Maintain regular communication with supervisor and nursing staff for expedited clinical screenings and care planning to support community planning and transition.
• Participate in monthly CTLP meetings.
• Complete monthly reports, accurately and on time.

Essential Functions/Qualifications:

• Bachelor’s degree in Social Work, Human Services or related field, preferred.
• Experience and/or strong interest in the field of human services via previous employment, internship, volunteer activity and/or additional studies.
• Regular and reliable attendance.
• Valid driver’s license and/or reliable transportation; insurance verification and motor vehicle record check.
• Organizational and time management skills.
• Communication Skills with employees, consumers, physicians, state and federal agencies, family members, providers (telephone, email or in person, as needed).
• Cultural competency and the ability to provide informed advocacy.
• Knowledge of home and community-based service systems and how to access and arrange services, MassHealth programs and public benefits (preferred).
• Have a high level of organization, maintain documentation standards, tracking and delivery of support to residents.
• Familiarity with state-wide health care network (preferred).
• Written communication skills.
• Demonstrated analysis and problem-solving skills.
• Able to develop and maintain positive effective relationships with providers, consumers, and the public.
• Works as a member of a team and independently.
• Maintain Confidentiality.
• Attention to detail.
• Computer acuity: software: Windows, Excel, Power Point, Outlook.
• Ability to be flexible and work in a fast-paced environment.
• Maintain caseload/production at program/department standards.

Physical Demands:

• Computer access.
• Ability to traverse homes, yards and stairways.
• Must be able to sit for periods of time at a computer or while driving.
• Must be able to carry files of up to 5 pounds and laptop.
• Occasional bending, reaching, twisting, standing and climbing.
• Frequent Standing and walking.

Work Environment:

Traditional office environment including work from home along with meeting consumers at their homes or in public places.

The basic function of the Benefit Enrollment Specialist is to assist older adults and younger people with disabilities to complete applications and access public benefits. 

Responsibilities:

• Participate in training and orientation sessions as assigned.
• Provide training and support for Tri-Valley staff, ESWA and Montachusett, regarding Benefit Enrollment Center, (BEC) services.
• Complete presentations to increase knowledge in the community of the function of BEC including but not limited to Senior Centers and ASAPS in Central Mass.
• Document activities regarding counseling sessions, progress notes, and correspondence in a prescribed format.
• Participate in activities to assist and promote BEC in gaining visibility and trust with Community agencies, providers and the public. Network in the community to develop new BEC application sites. Act as a liaison with Veteran’s Agents, hospitals, behavioral health centers and other community organizations that would benefit from BEC services for their consumers.  
• Follow the principles of consumer directed care.
• Provide the following services to consumers:
  • Provide support and information to client and those directly involved in client’s care.
  • Encourage self- advocacy.
  • Meet with consumers at a host site or at their home in order to provide information about core benefits including but not limited to Low Income Home Energy Assistance Program (LIHEAP), Medicaid, Supplemental Nutrition Assistance Program (SNAP benefits), Medicare Part D Extra Help- Low Income Subsidy (LIS), Medicare Saving Program (MSP) and provide assistance with application process as needed.
  • 30 day follow up to ensure that consumer has accessed chosen benefits.
  • Assistance in facilitating referrals and resources to community agencies as needed.
  • Assist with annual redetermination paperwork for benefits as consumer needs.
• Gather statistical data on a monthly basis.
• Examine statistics and make recommendations where outreach activities should be focused.
• Participate in staff meetings. 
• Maintain work area in a neat and professional manner.
• Meet with supervisor on regular basis.
• Participate in National and Regional BEC teleconferences and webinars.
• Participate in SNAP Coalition Meetings.
• Perform miscellaneous duties and assignments as directed by immediate supervisor.

Essentials Functions/Qualifications:

• Bachelor’s Degree in Human Services, Community Health, Social Work or related field preferred.
• Regular and reliable attendance.
• Must be able to communicate effectively telephonically and face to face.   
• Requires excellent written and verbal skills. 
• Computer acuity.
• Ability to be flexible and work in a fast-paced environment.
• Ability to work constructively as a team member.
• Current driver’s license, reliable transportation, willingness to travel throughout Central Massachusetts, meet DVR and liability insurance requirements.
• Ability to organize and plan work effectively.
• Knowledge and experience with the long term care and social service delivery systems, community resources and the local service systems for elders and person with disabilities.
• Knowledge and experience with:
  • Low Income Home Energy Assistance Program (LIHEAP)
  • Medicaid
  • Supplemental Nutrition Assistance Program (SNAP benefits)
  • Medicare Part D Extra Help- Low Income Subsidy (LIS)
  • Medicare Saving Program (MSP)

Physical Demands:

•  Computer access.
• Ability to traverse homes, yards and stairways.
• Must be able to sit for periods of time at computer or while driving.
• Must be able to carry files of up to 5 pounds and laptop.
• Occasional bending, reaching, twisting, standing and climbing.
• Frequent Standing and walking.

Work Environment:

Traditional office environment along with meeting consumers at their homes or in public places.

The basic function of the Residential Coordinator is to provide onsite services to housing residents.
A 35-hour, full time position is available in Northbridge.

Responsibilities:

• In collaboration with the staff of Northbridge, Uxbridge, Bellingham, Sutton, and Grafton Housing Authorities identify residents in need of services.
•  Provide assessment, outreach, early and/or crisis intervention and advocacy to diverse resident population.
•  Coordinate delivery of support services.
• Develop, implement and review comprehensive support service plans for residents, including connecting residents with needed in home supports.
• Work with Tri-Valley staff and other community agencies on behalf of residents.
• Collaborate with Housing Authority Directors to address the needs of residents at risk of eviction due to lease violations.
• Assist residents in changing/monitoring behaviors which, constitute lease violations to maintain tenancy, if possible.
• Provide counseling and support to residents concerning day-to-day adjustments.
• Provide on-going support for developing a cohesive sense of community by facilitating communication among residents.
• Coordinate educational/information programs at the developments.
• Provide technical assistance and education to housing staff concerning relevant elder and disability issues.
• Seeks appropriate housing arrangements for residents who require alternative housing.
• Complete monthly reports for DHCD.

Essential Functions/Qualifications:

• BA/BS Preferred; knowledge of housing/social services with elders or adults with disabilities preferred.
•  Knowledge of Housing/Disability laws and regulations.
• Solid written, verbal, interpersonal and team skills.
• Regular and reliable attendance.
• Communicate with consumers, co-workers, family members, both face to face, email and/or telephonically.
• Computer acuity; Software including Word and Outlook.
• Motor Vehicle, valid driver’s license; maintain minimum insurance liability requirements and complete motor vehicle driving record check.
• Organizational and time management skills.
• Communication skills to include public speaking.
• Cultural competency and the ability to provide informed advocacy.
• Knowledge of home and community-based service systems and how to access and arrange services.
• MassHealth programs.
• Outreach and educational services.
• Public benefits.
• Written communication skills.
• Demonstrated analysis and problem-solving skills.
• Meet deadlines in a timely fashion.
• Able to develop and maintain positive effective relationships with providers, consumers, and the public.
• Works as a member of a team & independently.
• Maintain Confidentiality.
• Attention to detail.
• Consumer Advocate.
• Ability to be flexible and work in a fast-paced environment.
• Maintain caseload/production at program/department standards.

Physical Demands: 

• Computer access
• Ability to traverse homes, yards and stairways.
• Must be able to sit for periods of time at computer or while driving.
• Must be able to carry files of up to 5 pounds and laptop.

 Work Environment:

• Traditional office environment along with meeting consumers at their homes or in public places.

To learn more about volunteering with Tri-Valley please visit the Volunteer Page.

The Personal Care Attendant program (PCA) is designed to help people of any age with chronic illnesses or permanent disabilities and need assistance with personal care tasks who are living in a home environment. Per diem RNs are needed to conduct assessments for the PCA program. MassHealth requires standard documentation and complete assessments for all people applying for services. The assessment itself takes approximately one hour to conduct. Per diem RNs are paid $80.00 for each completed assessment. The Tri-Valley, Inc. service area includes 29 towns in the Worcester County and Milford area.  Driver’s license, motor vehicle record check and minimum insurance requirements.