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Copy of Independent Living and Transition Specialist

Prime Home Health and Companion Care

Job Description

Job Description

Description:

Reports To: Supervisor (TA/ISCH)
Employment Type: Full-time/Part-time
Work Setting: This position requires the ability to work with individuals in facilities, apartments, and the community, as well as completing tasks remotely.

Position Summary

The Independent Living and Transition Specialist provides direct support to individuals transitioning from facilities to the community, as well as those already living independently through the waiver program. The Specialist plays a vital role in helping individuals secure affordable housing, maintain benefits, foster independence, and achieve long-term stability. This role requires flexibility, hands-on support, strong organizational skills, and the ability to adapt to changing needs. Specialists combine housing navigation, benefit management, community integration, and daily supports with consistent documentation and collaboration.

Key Responsibilities

Individual Support and Visits

  • Conduct in-person visits at facilities and in the community, with frequency determined by the individual’s plan of care, housing opportunities, or documentation needs.
  • Provide follow-up visits after individuals move into housing to ensure safety and successful adjustment.
  • Support individuals with day-to-day tasks such as budgeting, paying rent, attending appointments, grocery shopping, and community outings.
  • Promote independence and confidence through reminders, coaching, and role modeling.

Housing and Transition Assistance

  • Assist individuals in searching, applying, and interviewing for affordable housing opportunities.
  • Support lease signings and move-in processes, including shopping for and setting up essential furnishings and supplies.
  • Maintain housing logs and prepare individuals for housing recertifications to ensure continued eligibility.
  • Identify and address housing barriers (documentation, transportation, financial challenges).

Documentation and Application Readiness

  • Maintain accurate files of core documents (Social Security cards, IDs, proof of income, residency letters, benefit forms).
  • Create and maintain housing opportunity accounts, email accounts, and other required systems.
  • Record all services, visits, and progress notes in the agency’s electronic system.
  • Submit monthly billing documentation, receipts, and comply with authorization/consent requirements.

Benefits and Insurance Support

  • Assist individuals in applying for, maintaining, and recertifying health insurance and benefits such as SNAP, SSI, or SSDI.
  • Help organize paperwork, complete applications, and maintain active coverage.
  • Provide reminders and encouragement while fostering skills to manage these responsibilities independently.

Community and Social Engagement

  • Encourage participation in community activities such as senior centers, libraries, volunteer programs, and recreational outings.
  • Reduce barriers to engagement through coaching, reminders, and accompaniment when needed.
  • Support individuals in building social connections to increase stability and quality of life.

Transportation Support

  • Arrange or coordinate transportation for appointments, housing needs, errands, and community activities.
  • Work with PT1 services, approved private providers, or specialized transportation as appropriate.
  • Address transportation challenges by collaborating with supervisors and case managers.

Collaboration and Compliance

  • Communicate progress, barriers, and updates with Case Managers and Supervisors.
  • Coordinate with facility staff, housing authorities, benefit offices, healthcare providers, and other community resources.
  • Ensure compliance with agency policies, program standards, and timelines.
  • Complete incident reports when hospitalizations, ER visits, or other major incidents occur.

Ongoing Learning

  • Participate in trainings, in-services, and staff meetings to stay current on housing resources, program standards, and agency policies.
  • Continue building knowledge and skills to better support individuals’ independence.
Requirements:

Qualifications

  • High school diploma or equivalent required; degree or experience in social work, human services, or related field preferred.
  • Strong organizational and time management skills with attention to detail.
  • Effective communication skills and ability to adapt to diverse populations and changing needs.
  • Self-motivated, dependable, and capable of balancing fieldwork with administrative responsibilities.
  • Experience supporting individuals with housing, benefits, or community integration preferred.
  • Reliable transportation with current insurance required for facility, home, and community visits.
Vacancy posted a month ago
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