Caring, Integrity….What do you value?
Join us at Hartford
HealthCare at Home as we live our values every day. As part of Hartford
HealthCare we create a better future for healthcare in Connecticut and beyond.
By embodying these values we have become nationally respected for patient care
and most trusted for personalized coordinated care. Come be part of something
For over 115 years,
Hartford HealthCare at Home has been fulfilling our mission by enabling
individuals to achieve maximum independence, participate in their own plan of
care, and to live with dignity while receiving quality care in their own homes.
Our dedicated caregivers of HHC at Home use the latest in research and
education to develop a coordinated, consistently high standard of care for all
Care Coordinator works in collaboration with hospital case managers,
skilled nursing facilities, home care agencies, and physicians to coordinate
the care of patients moving from one level of care to another to insure a safe
transition across the post-acute care continuum. Serves as a bridge
between the healthcare team and the patient and/or caregivers. Provides
information and guidance to the patient and/or caregiver resulting in effective
care transitions, improved self-management skills and knowledge, and enhanced
communication between patient and healthcare team. Responsible for
building and expanding our relationships as well as identifying
opportunities to be a strategic partner, generating qualified referrals and
building new clinical initiatives.
and trust across the continuum of practices and facilities;
Identifying patients at
risk during transition to home care (or SNF) using standard tools of assessment
information and confirming accuracy using patient record and patient and/or
Conducting “at the
bedside“ meeting with patient and/or caregiver and following patient
during the post-discharge transitional phase. Following up with the
patient to ensure that patient is following transitional plans.
patient and family assessment to determine understanding and acceptance of
discharge plan and orders in conjunction with discharge planning staff to
ensure a smooth transition home.
Reviewing hospital discharge
summary and medication list with patient/caregivers, and assuring the
transitional care processes are implemented by engaging patients and care
givers in health self management, including medication management.
health literacy and using teach back method as learning tool.
Health Record and emphasizing patients' early recognition of health care risks
and symptoms to achieve longer term positive outcomes and avoid adverse events,
such as re-hospitalization.
communicating with Primary Care Providers and home care staff to insure
continuity of medical care through follow up appointments.
maintaining accurate patient records, charts and documents to support sound
hospital or physician personnel when patient is having difficulty following the
transitional care program; helps to identify and remove barriers to goal
attainment, and assists with intervention as needed
communicates with VNAHC management to make sure all issues and problems are
seamlessly handled so that both the patient and the hospital/physician are
satisfied with the results and process.
Participating in case
conferences at the request of hospital and/or community agency staff.
Provides consultation to
hospital staff on community resources and home care issues
Adheres to the practice
of confidentiality (HIPAA and other state/federal regulations) regarding
patients, families, staff, and Agency.
CT licensed LPN, RN, BSN
preferred. BA, BS or previous marketing experience
Three years experience
in marketing, clinical liaison or network account management. Home care