Arkos Health

Manager

• Work directly as a member of the Arkos Health Interdisciplinary Team
• Implement and participate in the patient’s plan of care; update and revise as needed
• Assist in coordination of comprehensive care; including obtaining referrals to other interdisciplinary services (Home Health, Palliative Care, Social Services) to help prevent further need for acute care utilization
• Maintain case load based on the needs of the client and/or contractual obligation
• Conduct face to face visits at a minimum of every 2 weeks for assigned patients enrolled in Intensive Case Management. May conduct increased face to face or telephonic visits based on the needs of the patient and or contractual obligation
• Complete Clinical and Social Assessments (CSA) to develop care plan upon initial start of care visit with patient
• Provide communication with patient’s providers and medical specialists regarding patient status and any changes in condition
• Engage with Arkos Health leadership and contracted providers to resolve changes in patient status, complaints, or complications though participation in weekly ICT meetings
• Complete medical reconciliation for all transitional care patients within 30 days of initiation of TCM contact

RN Care Manager - In-Home Assessment