Description

In this role, you will be responsible for coordinating activities surrounding 'Patient Centered Care. 'Patient Centered Care' activities include (but not limited to) identifying current and new patient populations through risk stratification lists and chronic conditions requiring one on one support in coordinating and managing care activities. This position provides comprehensive coordination of care for patient populations at risk for readmission. The level and intensity of care coordination is situational and appropriate based on patient need. Based upon operational needs, you may be embedded in any supported clinic, provide remote support, or serve as a float traveling to the practices that other CCCs are located for coverage to assist primary care physicians and the Primary Care Network (PCN) with full-time focus on case management support and coordination of care for patients identified in a risk group and complex tasks which will improve the patient experienc...