Hospital Transition Coordinator - full-time - 1st shift - Mon-Fri

Community Mental Health Affiliates, Inc. (CMHA); Waterbury (CT); On-site; USD 55,000 - 75,000; Full time

Job summary

Community Mental Health Affiliates, Inc. (CMHA) in Waterbury, CT seeks a full-time Hospital Transition Coordinator to support hospital-to-community transitions for Behavioral Health Home clients.

This role requires coordinating discharge plans, coordinating with hospitals, and arranging follow-up services to ensure seamless community reintegration. The position is based at our Waterbury location, Monday through Friday, with responsibilities including documentation, collaboration with hospital

Responsibilities

• Provides hospital-to-community transition services for CMHA clients, coordinating behavioral health support as outlined by program contracts.
• Maintains relationships with hospital inpatient units and emergency departments to notify CMHA of admissions and pending discharges.
• Engages clients and families in discharge planning and coordinates follow-up appointments, medication reconciliation, transportation, and community service linkage.
• Schedules and coordinates admissions/discharges, ensures proper documentation, and tracks status in the EMR system.
• Produces weekly reports on client status for clinical oversight meetings and coordinates with front desk and program leads.
• Develops new hospital partnerships to ensure successful transitions and referral processes within LMHA region and state systems.

Job description

Why CMHA?

Community Mental Health Affiliates, Inc. (CMHA) is a private non-profit treatment provider headquartered in New Britain, with seven locations throughout the city and in Waterbury. We partner with clients and the community to promote recovery from mental illness and substance use, treating more than 7,500 adults and children each year. CMHA is Connecticut’s first fully Joint Commission accredited Behavioral Health Home and is a SAMHSA Certified Community Behavioral Health Clinic (CCBHC). Visit cmhacc.org to learn more.

Internal mobility and career pathing is a focus at CMHA with many employees growing from individual contributors to leaders.

CMHA is looking to hire a full-time 40-hour Hospital Transition Coordinator for our CCBHC Program. This position will be located at our 255 Bank St. Waterbury, CT Location, Monday – Friday 8:30am-4:30pm

Position Summary:

Provides hospital-to-community transition services, including behavioral health services provided by CMHA, to patients enrolled in the Behavioral Health Home and other programming within the organization within identified best practice timeframes. Maintains positive working relationships with hospital inpatient units and emergency departments to develop and maintain systems to notify CMHA of agency client admissions and pending discharges. Engages individuals and their families in discharge planning and ensures patient discharge needs are met.

Essential Responsibilities

• Provides hospital-to-community transition services, including behavioral health services provided by CMHA, to patients enrolled in the agency’s Behavioral Health Home Program and other agency programming within timeframes specified by contract.
• Maintains good working relationships with hospital inpatient units and emergency departments to develop and maintain systems, including HIT/technology related systems, to notify CMHA of agency client admissions and pending discharges.
• Engages clients upon admission to the hospital and visits regularly to assist with discharge planning.
• Engages clients and their families in discharge planning and by providing needed resources and tools to ensure a smooth transition to community services.
• Upon discharge, ensures scheduling of follow up appointments, medication reconciliation, schedules transportation and coordinates other needed services.
• Responsible for coordination of admission and discharge records requested from agency and from area hospitals following inpatient hospital stays and/or emergency department visits.
• Responsible for tracking hospital admissions and discharges within the EMR and for scheduling appointments for clients through coordination with front desk and program area leaders
• Obtain weekly status on clients in the hospital and prepare reports for weekly clinical oversight meeting.
• Monitors pending discharges on a weekly basis for clinicians/medical staff to alert staff that clients need to receive follow up.
• Ensure that clients receive all necessary services upon discharge.
• Develop new relationships with hospitals CMHA does not have a working relationship with to ensure our clients are being transitioned successfully to community
• Assess and complete screening for clients in our LMHA region that need referral to the larger state hospital system, and develop working relationship with state hospital admission unit
• Attend Community Care Team Meetings (CCT) with the local hospitals being an active member representing the agency.
• All other duties as assigned.