Maintains professional relationship with internal and external stakeholders, such as inpatient, outpatient and community resources.
December 03, 2022
Assists with discharge/transition planning in collaboration with the multi-disciplinary team, actively engaging outpatient care providers by sharing hospital course, concerns, pending test results, learning needs, partnership opportunities etc.
January 02, 2023
Participates with multi-disciplinary work teams to develop and/or implement external disease management and care management programs.
January 11, 2023
Support Clinical Operations work with an interdisciplinary team of triage nurses, transition of care nurses, care coordinators, health coaches, medical directors, providers.
February 07, 2023
Develops and implements analysis and reporting programs for the organization and/or other population health management activities by ensuring data aggregation, measurement, analysis, and reporting to support improvement and redesign.
February 10, 2023
Attend meetings, record minutes, capture action items and track progress on open items pertaining to the Care Management Development Committee.
February 16, 2023
Works with multidisciplinary staff to ensure patient / family has received appropriate information and education prior to transition to the next level of care.
March 18, 2023
Demonstrate effective, professional, tactful and appropriate written, verbal, and non-verbal communication skills with patients and family members, medical staff, colleagues, other departments and vendors.
May 02, 2023