Inpatient Discharge Care Manager

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

23h•$70,500 - $94,000

About The Position

Community Health Network of Connecticut, Inc. (CHNCT) is seeking an Inpatient Discharge Care Manager in the Greater New Haven, Connecticut area. The role collaborates with hospitals, primary care providers, home health agencies, members, CHNCT Intensive Care Managers, and other partners to identify clinical and social barriers that contribute to readmissions and develop comprehensive, safe discharge plans. The care manager meets with hospitalized members to assess physical, cognitive, psychosocial, and outpatient-support needs; provides education on HUSKY Health and community resources; and communicates gaps in care and discharge barriers to the relevant care team. The position also helps develop outpatient strategies for follow-up care, appropriate care settings, and social determinants of health. The role conducts face-to-face hospital visits and comprehensive assessments, coordinates alternatives to acute care, discusses anticipated discharge plans with providers and care managers within two days of admission, participates in collaborative meetings, initiates referrals, and refers Quality of Care issues to Quality Management. It maintains collaborative relationships, uses referral criteria to direct members to appropriate CHNCT departments, helps address risks related to emergency department overutilization and readmissions, and maintains knowledge of CHNCT programs, community resources, vendors, and Medicaid covered benefits. CHNCT offers medical, dental, and vision coverage options; flexible spending and health savings accounts; group term life insurance; a 401(k) plan with company matching and immediate vesting; voluntary accidental injury coverage; tuition reimbursement and continuing education opportunities; paid leave and company holidays; and a wellness program. CHNCT states that it is committed to an inclusive and accessible interview process and can provide reasonable accommodations upon request.

Requirements

Minimum of 2 years of direct clinical care experience as a Registered Nurse.
Current, unrestricted RN license.
Active Registered Nurse license.
State motor vehicle license.
Strong verbal and written communication skills.
Excellent organizational skills and ability to manage multiple priorities concurrently.
Strong critical-thinking and problem-solving skills.
Ability to work independently and in a team environment.
Tact and diplomacy when handling highly sensitive information and issues.
Strong computer and keyboard skills.
Flexibility in covering assignments.
Two to four years of post-secondary schooling is desired.
Associate's degree; a bachelor's degree is preferred.
Nursing major is desired.

Nice To Haves

Case Management experience preferred.
Knowledge of Medicaid regulations preferred.
Bachelor's degree preferred.

Responsibilities

Collaborate with hospitals, PCPs, home health agencies, members, and CHNCT Intensive Care Managers to identify clinical and social determinants contributing to readmissions and develop comprehensive discharge plans.
Meet with hospitalized members to assess barriers to safe discharge, including physical needs, cognitive deficits, psychosocial needs, and lack of a PCP or other outpatient support.
Provide members with health education and information about HUSKY Health and community resources.
Communicate gaps in care and barriers to safe discharge to the hospital care coordinator, attending physician, ICM, and PCP.
Partner with the care team to develop outpatient strategies covering provider follow-up, appropriate care settings, and social determinants.
Complete face-to-face visits with members in the hospital.
Conduct comprehensive assessments of member history and current presentation to identify needs and develop multidisciplinary interventions.
Explore and coordinate appropriate alternatives to acute care, and communicate recommendations to the attending physician, member or authorized representative, and hospital care coordinator.
Discuss anticipated discharge plans with inpatient providers, PCPs, ICMs, and outpatient providers within two days of admission.
Participate in internal and external collaborative meetings.
Initiate referrals as necessary.
Identify and refer Quality of Care issues to the Quality Management department.
Develop and maintain collaborative relationships with internal constituents and hospitals/providers.
Interact successfully with business partners.
Use referral criteria to triage members to appropriate CHNCT departments.
Collaborate on reviews of members at risk of ED overutilization or readmission and work with the care team to formulate plans to address risks.
Maintain knowledge of CHNCT programs, other ASO and community programs, vendors, and covered Medicaid program benefits.
Perform other duties as assigned.