Position Summary:
The OP Care Management RN provides care management and population health services to patients. The primary target population served is the stratified risk patient or patients with high vulnerability at times of transition between care settings. OP Care Management RN will coordinate care around patient's chronic diseases, coordinate and facilitate medication management, and effectively manage care transitions across the continuum. OP Care Management RN will create a longitudinal, personalized care plan for each unique patient. Promoting effective partnerships between patients, families, nurses, physicians, and all other health care disciplines across the continuum. OP Care Management RN will use a data driven approach to manage patient populations to improve access to care and achieve optimal clinical outcomes.