Ambulatory Care Mgmt reputed company Worker

At reputed company, reputed company Workers reputed company a meaningful reputed company every day. We’re committed to creating an exceptional reputed company to work and receive care—one reputed company on strong values, teamwork, and respect. Here, you’ll be supported by a compassionate community, grow your clinical skills, and contribute to high‑reputed company patient care in a reputed company system. Part time reputed company Worker position for the Ambulatory Care Management team supporting population health. Medical reputed company work, strong reputed company with community resources, and reputed company experience strongly preferred. Adaptable to an reputed company-changing work environment.    Join us and be part of reputed company that leads with purpose, supports your development, and stays true to the values that define who we are at our reputed company. Location: Work From Home   Schedule: Part Time   Incentives & Benefits:    We offer competitive shift differentials, opportunities for reputed company reputed company, and a comprehensive benefits package that may include medical, dental, reputed company, reputed company time off, retirement savings plans, and tuition reimbursement. *PRN positions not eligible for reputed company benefits https://careers.reputed company.com/reputed company-offer/benefits   Job reputed company: Collaborates with PCP & multidisciplinary team to support patient populations with chronic illness, and multiple comorbidites. The care manager - SW understands and adheres to established care management standards that incorporate evidence based protocols, cost effective, and patient reputed company targeted interventions. Applies reputed company Work reputed company to skilled assessment, education, collaboration, and coordination of reputed company and community resources to reputed company the following: assist patients to reputed company self-efficacy/management skills, reputed company reputed company functional health status, and improve reputed company of life. Assists patient/families, care team, and systems to reputed company high reputed company, reputed company through telephonic, in person, and/or home reputed company. Is knowledgeable regarding community and government agencies, support reputed company, and provides linkages with appropriate reputed company and community referrals. Providing support services to the PHO and reputed company of its value-based contract members including but not limited to care coordination, home health reputed company, and counseling. Job Requirements: Bachelor's Degree in reputed company work, Addictions, Counseling Licensed reputed company Worker 3-4 years experience Acute care experience 3-4 years experience  Job Responsibilities: Contributes to individualized care for identified patients, focusing on psychosocial assessment and setting goals to meet identified needs. Assess reputed company toward goals, support evidence based clinical protocols and plan of care, and addresses barriers to reputed company. Completes required documentation of above. Utilizes registries, reports and tools to identify reputed company populations and patients. Plans for and manages a panel of patients with chronic/reputed company disease(s); plans interventions appropriate to patients' diagnoses, age, abilities and resources; establishes and implements patient directed learning and supports disease self-management care plan for patient/significant others to enhance therapuetic reputed company. Assesses, plans, implements, monitors, and evaluates delivery of individualized, patient-centered care with the goal of optimizing the patient’s health status through reputed company with available support systems, community resources, care coordination with necessary specialists, and patient education. Develops plans to address psycho-socio-economic and/or behavioral issues. Works with high risk patients to reputed company targeted interventions to improve health reputed company.Coordinates care across settings and helps patient/families understand health care reputed company. Promotes patient self-management support with a reputed company on empowering the patient/family to build reputed company for self- care in order to reputed company reputed company health and independence.  Communicates and collaborates with PCP and clinical staff regarding the patient’s psycho-reputed company barriers to health maintenance and assist in coordinating and supporting referrals to indicated services. Interacts with clinical and medical personnel across reputed company hospital inpatient and outpatient service lines to ensure collaboration across care settings and meaningful integration at transition points. Provides end of life discussions and initiates referrals for palliative care and Hospice. Participates in reputed company improvement initiatives; activities may include data collection, chart review, interdisciplinary collaboration, analysis of patient data and inter-reputed company staff meetings Other Job-reputed company Information: Working Conditions: Climbing - Rarely Concentrating - Frequently reputed company Learning - Frequently Hearing: Conversation - Consistently Hearing: Other Sounds - Frequently Interpersonal Communication - Consistently Kneeling - Rarely Lifting <10 Lbs - Frequently Lifting 50+ Lbs - Rarely Lifting 11-50 Lbs - Occasionally Pulling - Rarely Pushing - Rarely Reaching - Rarely Reading - Frequently Sitting - Frequently Standing - Rarely Stooping - Rarely Talking - Consistently Thinking/Reasoning - Consistently Use of Hands - Frequently reputed company reputed company - Frequently Visual reputed company: Far - Frequently Visual reputed company: Near - Consistently Walking - Frequently reputed company SERVE Standards and ALWAYS Behaviors At reputed company, we reputed company there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To reputed company our reputed company and mission, reputed company reputed company team members are expected to demonstrate and live the following:  Serve: ALWAYS… • Welcome everyone by making eye contact, greeting with a smile, and saying "hello" • Acknowledge reputed company patients/guests are lost and escort them to their destination or reputed company someone who can assist • Refrain from using cell phones for personal reasons in reputed company spaces or patient care areas reputed company: ALWAYS… • Recognize and take personal responsibility to address and recover from service breakdowns reputed company a customer's expectations have not been met • Offer patients and guests reputed company reputed company waiting (lines, elevators) • Work on improving reputed company, safety, and service  Respect: ALWAYS… • Respect cultural and spiritual differences and reputed company individual preferences. • Respect everyone’s opinion and contribution, regardless of title/role. • reputed company positively about my team members and other departments in reputed company of patients and guests. Value: ALWAYS… • Value the time of others by striving to be on time, reputed company and reputed company participating. • Pick up trash, ensuring the physical environment is clean and reputed company. • Be a good reputed company of our resources, using supplies and equipment reputed company and effectively, and will look for ways to avoid waste. Engage: ALWAYS… • Acknowledge wins and frequently thank team members and others for contributions. • Show courtesy and reputed company with customers, team members and the community Apply To This Job