CBI Home Health is looking for a dynamic and compassionate Integrated Care Lead to be in an innovative and collaborative transitional program that includes working with an interdisciplinary team that uses an integrated and collaborative approach to service delivery. CBI Home Health has demonstrated that In-Home care can be different with evidence of improved outcomes and satisfaction for employees and patients. CBI Home Health has strengthened the traditional In-Home service delivery model focusing on a holistic approach to care.
As the primary contact for a hospital partner, the Integrated Care Lead will manage referrals and client intake while working with hospital lead, patients and families, and other community partners, to create individualized and holistic plans of care to support patients to transition home with wrap around services and remain at home. Your role is vital in coordinating smooth discharges from hospital to home, working with the circle of care to ensure the progress of patient care plans and identifying solutions and innovative approaches to meet patient needs. As the Integrated Care Lead you will be the primary contact to front line providers, community partners and the after-hours team, to aid in the resolution of any concerns related to client wellness and care. The Integrated Lead may participate in interdisciplinary discussions (huddles, rounds), and lead discharge and transition planning meetings that will result in smooth patient transitions.
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