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.
January 15, 2020
Participates with multi-disciplinary work teams to develop and/or implement external disease management and care management programs.
February 12, 2020
Maintains professional relationship with internal and external stakeholders, such as inpatient, outpatient and community resources.
February 22, 2020
Attend meetings, record minutes, capture action items and track progress on open items pertaining to the Care Management Development Committee.
April 13, 2020
Utilize and interpret patient data from EPIC EMR, Phytel, payer information and other resources for quality improvement activities, identification of high risk patients, gaps in care, preventive health needs, utilization review/management and other pertinent patient related information.
May 20, 2020
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.
May 29, 2020
Support Clinical Operations work with an interdisciplinary team of triage nurses, transition of care nurses, care coordinators, health coaches, medical directors, providers.
June 03, 2020