Job Details
Locate, outreach and engage members within the community that clinicians and care navigators have not been able to reach; create a positive experience and relationship with the member Assesses functional and social needs of members and collaborates to develop and implement solutions with the frequency established in the model of care Work collaboratively the multidisciplinary team to engage resources and strategies to address medical, functional, and social barriers to care Works closely with clinicians to help bridge the gap for these previously un - engaged members and members with whom contact was lost Completely and accurately document in patients electronic medical record Provide patients and family members with education regarding the need for follow up as appropriate during each patient visit Actively participate in organizational quality initiatives Participate in collaborative multidisciplinary team meetings to optimize clinical integration, efficiency, and effectiveness of ca...Health, Worker, Remote, Healthcare