Inpatient Discharge Care Manager

Community Health Network of Connecticut, Inc.•Wallingford, CT

11h•$70,500 - $94,000•Onsite

About The Position

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking an Inpatient Discharge Care Manager in the Greater Hartford, CT area. This role involves collaborating with various healthcare professionals and community resources to develop comprehensive discharge plans for patients, assess barriers to safe discharge, provide health education, and coordinate outpatient care strategies. The position requires a strong understanding of patient needs, including clinical, social, and psychosocial factors, and the ability to navigate available healthcare and community resources.

Requirements

Minimum 2 years direct clinical care experience as an RN is required.
Strong verbal and written communication skills.
Excellent organizational skills, ability to manage multiple priorities concurrently.
Demonstrates strong critical thinking and problem solving skills.
Ability to work independently and in a team environment.
Uses tact and diplomacy for highly sensitive information and issues.
Team player.
Strong computer and keyboard skills.
Flexible in covering assignments.
RN license must be current and unrestricted.
Active Registered Nurse License
State motor vehicle license

Nice To Haves

Case Management experience preferred.
Knowledge of Medicaid regulations preferred.

Responsibilities

Collaborate with hospital, PCP, home health agency, member, and CHNCT Intensive Care Managers (ICM) to identify and address clinical and social determinants that contribute to readmissions to develop a comprehensive discharge plan.
Meet with members who are inpatient to assess barriers to safe discharge including physical needs, cognitive deficits, psychosocial needs, and/or lack of a primary care physician or other outpatient support systems in place.
Provide health education and information on available HUSKY Health and community resources to members.
Communicate gaps in care and barriers to safe discharge with hospital care coordinator, attending physician, ICM and Primary Care Provider (PCP).
Partner with team to develop outpatient strategy to include proper follow up with physicians/specialty providers, obtain care in the appropriate setting, and address social determinants.
Complete face to face visits with members while in the hospital.
Conduct comprehensive assessment of member history and current presentation to identify needs and develop multidisciplinary interventions.
Explores and coordinates appropriate alternatives to acute care and communicates recommendations to attending physician, member/authorized representatives, and hospital care coordinator to facilitate appropriate and timely action.
Discusses anticipated discharge plans with the inpatient providers/PCP, ICM and outpatient providers within two days of admission.
Participate in internal and external collaborative meetings.
Initiate referrals as necessary.
Identifies and refers Quality of Care (QOC) issues to the Quality Management department.
Perform other duties as assigned.
Develops and maintains collaborative relationships with internal constituents and hospitals/providers.
Successfully interacts with business partners.
Utilizes referral criteria for triage of members to appropriate CHNCT departments.
Collaborates to review members with potential ED over utilization risks (i.e., multiple co-morbid conditions, pain management, behavioral health issues, alcohol/substance abuse, and chronic pain) and readmissions, and works with the care team to formulate plans to address.
Maintains knowledge of CHNCT programs, other ASO and community programs, vendors, and covered benefits for the Medicaid programs.