In this role, you will provide care coordination services to Providence Health Plans (PHP) members, including: Disease management programs, in Educating, Motivating and Empowering members to manage their disease.
In this role, you will ensure coordination of care delivery processes, to include alternate healthcare settings and the home environment, for the purposes of enhancing the patient's health and wellness, safety, productivity, and quality of life, and for providing the most beneficial, cost-effective health care.
In this role, you will work with patients/families/caregivers and the interdisciplinary team to enable patients to progress towards care goals and be prepared for timely transition to the appropriate level of care in the community.
In this role, you will provide across-the-continuum, customized care coordination services and management of transitions of care for the most medically fragile Providence Health Plan (PHP) Medicare Advantage, at-risk patients, and their families/caregivers.
In this position, you will work with patients/families, physicians, nurses, social workers, and other health team members to enable each patient to progress towards care goals and be prepared for timely discharge or transfer.