RN Care Manager - Case Coordination

RN Care Manager – Case Coordination

Hartford Health Care

Location Detail: Charlotte Hungerford Hospital (10115)

Shift Detail: Per Diem for 8‑hour shifts during the week and weekends

Work where every moment matters.

Every day, more than 40,000 Hartford Health Care colleagues come to work with one thing in common:
Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.

Charlotte Hungerford Hospital is a 122‑bed, general acute‑care community hospital located in Torrington, Connecticut, that serves as a regional health‑care resource for the 100,000 residents of Litchfield County and Northwest Connecticut. CHH offers personalized attention from an expert team of caregivers and physicians that utilize advanced technology and clinical partnerships in a convenient, safe and comfortable patient environment.

Care Management is a collaborative practice model that includes patients, nurses, social workers, physicians, healthcare team members, caregivers, and the community. The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of the Care Management Team are to achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s right to self‑determination.

Incumbents of this position are professional Registered Nurses who utilize the nursing process (assessment, planning, intervention, documentation, and evaluation) to determine and facilitate the most appropriate level of care and identification of discharge needs. They collaborate with physicians to ascertain the medical treatment plan and with nursing and other health‑care team members and health plans to fulfill the treatment plan in the highest quality, cost‑effective manner.

Responsibilities include ensuring customer satisfaction (patient, family, physician, others), maintaining patient confidentiality, and being sensitive to the age and cultural‑specific patient needs for comfort, privacy and generalized care.

• Displays and upholds CHH core values of dignity, compassion, service excellence, community and integrity.
• Strives to gain respect and maintain dignity for patients, family members, visitors, and all CHH personnel. Demonstrates a diplomatic and supportive attitude and presents the hospital positively to all persons above and below.
• Responsible for complete and thorough patient and family assessments for initial and ongoing care and discharge planning, addressing physical, psychosocial, religious, cultural and educational aspects.
• Communicates appropriate information from patient, family, chart, community agencies and colleagues to other members of the multidisciplinary health‑care team. Actively coordinates patient care including sequencing and scheduling of tests, procedures, and consultations.
• Works closely with physicians to coordinate hospital services from pre‑hospital through post‑discharge recovery.
• Ensures patients and families understand the diagnosis and planned course of treatment. Identifies gaps or barriers to care and facilitates inter‑departmental communication to expedite appropriate changes.
• Assists Social Worker Care Managers with highly complex clinical patient needs.
• Responds expeditiously to emergency needs of patients and families in crisis by providing appropriate interventions necessary to support and stabilize.
• In conjunction with patient, family, payers and other members of the health‑care team formulates and implements a discharge plan to address assessed needs and patient and family concerns. Evaluates the effectiveness of the plan and revises as needed to achieve desired outcomes.
• Refers patients to a variety of resources including visiting nurse agencies, skilled nursing facilities, long‑term care hospitals, rehab facilities, hospice care, durable medical and respiratory care providers.
• Ensures follow‑up care with providers is arranged with confirmation of the patient’s ability to access the scheduled appointment.
• Conducts telephone…