RN Care Manager Transitns-Advance Care

Responsibilities:- Facilitate a collaborative process of assessment, planning, care coordination, and evaluation to meet the comprehensive health needs of identified individuals or families within the designated population.- Serve as a liaison between physicians, hospitals, emergency departments, nursing homes, and other healthcare providers and resources.- Support a multidisciplinary team approach directed toward prevention, education, and health promotion in panel of patients.- Ability to establish supportive relationship with patients, care givers, and families.- Assist in the development of network protocols and processes for care management of high risk and rising-risk patient population.- Maintain focus of patient needs as well as network needs for population...