Transition Care Coordinator

Trillium Health Resources

Transition Care Coordinator providing care coordination for individuals in special needs populations. Collaborates with licensed Clinicians and Registered Nurses for treatment planning and assessment.

Posted 7/8/2026full-timeRemote • North Carolina • 🇺🇸 United StatesJunior💰 $54,106 - $67,210 per yearWebsite

About the role

Key responsibilities & impact

Responsible for providing care coordination (treatment planning, assessment, monitoring, educating, and referral/linking) to individuals identified in the Transitions to Community Living Initiative Special Needs Populations (TCLI)
Work collaboratively with licensed Clinicians, Registered Nurses, and Peer Support Specialists to ensure successful discharge/transition planning/post transition monitoring
Provide care coordination/care management to assigned TCL individuals who may have identified needs with behavioral health, physical health, co-occurring, co-morbid, or multi-morbid conditions
Assess member’s needs who have transitioned into supportive housing to determine if additional support and services are needed for continued independent living
Ensure timely and accurate documentation of all planning and coordination efforts in multiple software platforms and State database systems

Requirements

What you’ll need

Master’s degree in a human services field or licensure as an RN and one (1) year of relevant experience working directly with individuals with SED or SMI
OR Bachelor’s degree in a human services field or licensure as an RN and three (3) years of relevant experience working directly with individuals with SED or SMI
Must have a valid driver’s license
Must reside within Trillium’s North Central Region or South Central Region, which includes specific counties
Must be able to travel within catchment as required
Preferred: Experience and knowledge of peer support and experience working with individuals who are certified peer support specialists.

Benefits

Comp & perks

Health Insurance with no premium for employee coverage
Flexible Spending Accounts
24 days of Paid Time Off (PTO) plus 12 paid holidays in your first year
NC Local Government Retirement Pension (defined-benefit plan)
401k with 5% employer match and immediate vesting
Public Service Loan Forgiveness (PSLF) qualifying employer
Quarterly stipend for remote work supplies

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

AssessmentMonitoringReferral/LinkingCare ManagementSupportive Housing Assessment

Soft Skills

CollaborationEducationCommunication

Certifications

Master’s Degree in Human ServicesBachelor’s Degree in Human ServicesRegistered Nurse Licensure