Peer Care Transition Specialist
Listed on 2026-09-21
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Healthcare
Community Health, Patient/Health Advocate, Mental Health, Human Services/ Social Work -
Social Work
Community Health, Patient/Health Advocate, Mental Health, Human Services/ Social Work
Peer Care Transition Specialist
Position Type:
Full-time, Non-exempt
Reports to:
Regional Director of Clinical Behavioral Health and Peer Integration Services
Base
Location:
Chappaqua/Westchester
Schedule:
Monday - Friday 9am-5pm
Pay Rate: $25.00/hr
This position is covering Westchester County and is co-located within medical facilities
About Independent Living, Inc.
Since 1987, Independent Living, Inc. (ILI) has been increasing access, encouraging self-determination, and advocating for the rights of people with disabilities throughout the Hudson Valley of New York. Following the traditional independent living center (ILC) model, the majority of ILI's board and staff are individuals with disabilities, bringing valuable peer and life-experience perspectives to the services we provide.
ILI is committed to empowering individuals to live independently and participate fully in their communities.
Why Work with Us?
- Join a mission-driven organization dedicated to building a barrier-free society and supporting independent living
- Be part of a collaborative workplace that embraces diversity and innovation, where every team member's voice and lived experience are respected and valued
- Be part of an organization that champions inclusive hiring practices and actively welcomes individuals of all abilities, recognizing the value of both visible and non-visible disabilities
- Help individuals successfully transition from hospital settings back into the community while making a meaningful impact on recovery outcomes and quality of life
- Work alongside hospitals, behavioral health providers, peer specialists, and community organizations to improve continuity of care and reduce barriers to services
About the Role
The Peer Care Transition Specialist serves as a vital support and advocacy resource for individuals transitioning from hospital and behavioral health settings back into the community. Reporting to the Regional Director of Clinical Behavioral Health and Peer Integration Services, this role works collaboratively with hospital staff, behavioral health providers, Hudson Valley Care Coalition (HVCC) network partners, and community-based organizations to promote continuity of care, reduce barriers to treatment, and strengthen long-term recovery outcomes.
Using lived experience and a recovery-oriented, trauma-informed approach, the Peer Care Transition Specialist helps individuals navigate post-discharge services, engage in behavioral health and medical care, and access community-based supports that promote wellness, stability, and independence. This position also supports Social Care Network (SCN) initiatives through screenings, referrals, and coordination of Health-Related Social Needs (HRSN) services.
What You'll Do
- Provide peer-based support, mentorship, advocacy, and engagement to individuals during hospitalization and throughout their transition back into the community
- Serve as a bridge between hospital-based care, outpatient clinics, peer support services, and community-based providers to promote continuity of care and successful community reintegration
- Collaborate with hospital staff, HVCC network providers, care managers, Health Homes, behavioral health providers, and community organizations to support safe discharge planning and coordinated care
- Facilitate warm handoffs and ongoing engagement with outpatient clinics, peer support staff, and community programs to strengthen treatment connection and reduce barriers to care
- Support individuals in attending post-discharge behavioral health, medical, and primary care appointments through care coordination, reminders, transportation assistance, and follow-up outreach
- Conduct forty-eight-hour, seven-day, and thirty-day post-discharge follow-up contacts, as appropriate
- Assist individuals in identifying goals, strengths, needs, and barriers related to recovery, wellness, and successful community reintegration
- Connect individuals and families to community-based resources, including housing supports, food assistance, transportation, benefits, care management, and other social care services
- Complete Social Care Network (SCN) screenings, assessments, referrals, and navigation activities in compliance with program and payer requirements
- Collaborate with HVCC network providers and community partners to ensure timely linkage to eligible Health-Related Social Needs (HRSN) services
- Utilize lived experience appropriately to provide encouragement, hope, mentorship, and recovery-focused support
- Advocate alongside individuals to…
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