Gainesville, GA26 days ago
Other duties of the RN Lead Care Manager include, but are not limited to, implementation of policies and procedures, to support care management programs and promote collaboration, supervise and provide support to ensure services reach the target populations, assist with developing and facilitating training for HP2 Care Management staff, serves as a liaison between the organization and community partners, to advocate for patients, lead interdisciplinary team meetings, to identify concerns/issues and implement strategies and interventions, consultation with members on their medications and durable medical equipment, review member care plans, address home care needs, and connect members to community resources; collaboration with primary care physicians and other providers to ensure there are no gaps in care; collaboration with members, providers, and care givers to ensure positive care outcomes during care transitions. Tailors interventions that are multi-faceted, improve quality and cost effectiveness to meet the patient's need while respecting the patient's role as a decision maker in the care planning process: Effectively uses the following tools/strategies that include, but are not limited to: evidence-based guidelines and practices, interactive care plan developed based on patient-set priorities where applicable, collaboration with multidisciplinary care teams, meet medical home (PCMH) requirements, physical/behavioral health integration, and patient self-management education and training.