Responsibilities include but are not limited to:

• Assists in the development of a comprehensive complex care management plan, with particular emphasis on medically complex issues.
• Works with patient/caregiver/co-learner to develop goals, informs care team if inappropriate for complex care and makes recommendation for care plan in usual care teams.
• Provides clinical support and direct care management including patient education, goal setting, self-management teaching and coaching for the high risk patients.
• Interacts with patients and patient caregivers as appropriate to ensure continuity of care, patient adherence to care plans, and identification of barriers preventing adherence to care plan.
• Works with care management team to identify client/patient need for advocacy in the area of accessing health and behavioral health systems and services, entitlements and community resources
• Documents and communicates client needs to care management team
• Performs all other duties as required

Requirements:

• LPN Graduate from an accredited school. Must have a current Connecticut State Licensure.
• Minimum of one (1) year experience in a long-term care facility or rehabilitation center. Clinic experience is highly desirable.
• Excellent Patient Management skills.
• Must be strongly motivated and able to accept supervision.
• Computer skills are essential with the ability to learn AS400, SRS, MDLink and Mednexus.
• Ability to provide phone triage along with knowledge of referral process, medication refill procedures and Hollister charting are also required.
• Knowledge of CLIA waived lab testing, Urine Dipsticks and Gucometers are necessary.
• Bilingual individual is desirable

CS-HHC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.