RN Trans. Care Associate

Overview: Under the supervision of Care Coordinator Manager/Supervisor, Primary Care performs tasks and patient contact to assist in the coordination of patient primary care services. Services include obtaining and running reports to assist with review and resolution of care gaps. Responsibilities: Reviews monthly Care Gap data from the Managed Care Department for Family Medicine and General Medicine clinics. Performs Transitional Care Management, (TCM) non face-to- face patient visits per policy and procedure Contacts insurance Case Managers under the direction of the Care Coordinator Manager/Supervisor, and implements plans to follow up with patients, or to include phone calls, video discussions to assist in preventing or reducing ED visits. Reviews Healthy Planet Performance of each clinic monthly and identifies measures that require improvement and communicates to Care Coordinator Manager/Supervisor. Maintain a positive customer service oriented disposition toward all clients and co-workers. Provide excellent customer service with internaland external customers.