CN II, Case Mgmt - Care Transition & Complex Care Programs

Summary SUMMARY: Responsible for providing comprehensive case management services to clients identified with complex health conditions and social challenges that are at risk for health status decline. The goals and focus of these service efforts are to provide timely delivery of intensive case management services across multiple domains, including the community, ambulatory and specialty care settings, to prevent further health deterioration and reduce the need for more costly services such as acute care hospitalization and to develop self-management skills that improve his or her long-term health status.

Incumbent performs all duties and responsibilities in accordance with the values of the organization. Performs related duties as required. DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: Following are the duties performed by employees in this classification.

However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification. 1.

Acts as a liaison with primary care providers for identified groups of hospitalized clients. Maintains close working relationships with identified community-based providers. Visits clients/potential clients in both hospital and community settings, including private homes.

Provides own transportation to community based visits. 2. At times, supervises Student Nursing Interns and/or Medical Assistants.