Attention current TriHealth employees:
Please apply for this position by submitting an online internal application via SuccessFactors.Please be certain to update your SuccessFactors Employee Profile prior to applying to this position.
AMBULATORY COMPLEX CARE COORDINATOR-REGISTERED NURSE: The goal of Ambulatory Complex Care Management is to improve and increase appropriate utilization of healthcare such as ED visits, inpatient admissions, and readmissions. This goal is accomplished through longitudinal care management interventions that increase patient self-management activities and improve quality of life. Ambulatory Complex Care Mangers will provide care management to a minimum panel of 110 High Risk patients collaboratively with Primary Care, Specialty providers, Social Workers, Population Health Pharmacists, Community Health Workers, and other specialty care management teams across the continuum of care. Providing support services to the PHO and all of its value-based contract members. Using evidence based care such as Standards of Practice for Case Management and NCQA Standards for Case Management, the Ambulatory Complex Care Managers analyze and identify High Risk patient population using both clinical and claims information for those needing care management services and transitions of care patient contacts. For transitions of care, the care managers will contact patients within the established guidelines for transitions of care. Ambulatory Complex Care Managers will utilize established protocols for enrollments of patients into Complex Care Management, i.e. enrollment Assessments will be completed within established guidelines from identification for Care Management need, develop individualized patient goals and interventions to reach goals, assist patients with achieving goals through education and counseling, and referrals to additional resources as needed. As patients do achieve their health related goals, Ambulatory Complex Care Managers will re-assesses further needs and will graduate patients who meet criteria or will sets new goals and interventions to assist patient in appropriate utilization and improved quality of life.
EDUCATION: Other RN Registered Nurse
EXPERIENCE: 2-3 years Clinical Nursing 2-3 years Clinical Nursing Patient Centered Medical Home experience
SPECIALIZED KNOWLEDGE: Progressive exp as an RN in hospital, ambulatory or home health setting. Strong oral, written communication, customer service skills. Collect data, generate reports & provide analysis. Work with physicians, colleagues, computers & EMR..
Job Title: AMBULATORY COMPLEX CARE COORDINATOR-REGISTERED NURSE
Department Name: THPP AMBULATORY CARE COORD
Employment Status: Full Time Position
Weekend Commitment: No
Holiday Commitment: No
On-Call Commitment: No
TriHealth is an equal opportunity employer. We are committed to fostering a diverse and inclusive workforce.