Midland, Michigan12 days ago
Advocate, mediate, and negotiate, with an emphasis on self-determination for the patient system, to formulate a cohesive plan for maintaining the patient's health status, improving social supports, and moving the patient safely into less restrictive, less costly levels of care according to available resources. During Care Coordination Rounds, RN CM communicates with the healthcare team a patient-centered plan that is needs based, appropriate to patient resources, timely and addresses the risk of readmission.