Healthcare Manager
Current-Responsible for successfully supporting patients with high risk health conditions to navigate the healthcare system-Assists in developing patient empowerment by acting as an educator, resource, and advocate for patients and their families to ensure a maximum quality of life.-Interacts and collaborates with multidisciplinary care teams, to include physicians, nurses, pharmacists, laboratory technologists, social workers, and other educators-Works independently in a self-directed environment and performs all nursing duties. -Works with the providers and clinic staff to identify patients at high risk.-Supports longitudinal care of the patient with chronic care conditions by performing assessment of health conditions.- Performs motivational interviewing and self-management goal setting with patients. -Creates referrals to appropriate agencies and resources-Supports transition of the patient with chronic care conditions from inpatient to outpatient setting, by performing assessment of transitional needs, discharge planning, performing medication reconciliation, establishing and reviewing contingency plan, by providing patient education.-Coordinate with providers to establish or update plan of care-Performs accurate and timely documentation in the electronic medical record-Participates in daily huddles and Patient Care Coordination (PCC) meetings-Prepares accurate and timely reports, as required, for weekly meetings.-Maintains continued competence in nursing practice and knowledge of current evidence-based practices.
