MOLECHEX SKIN CANCER CLINIC

Manager

• Manage high risk and chronic illness to promote whole-person, integrated, quality care
• Conduct in-office patient visits as outlined in care plan
• Create and promote engagement with a care plan, developed with the patient, primary care provider and/or specialty care provider and family/caregiver(s)
• Support the delivery of integrated, whole-person care in family medicine, recovery and psychiatric care
• Engage patients in self-management and shared decision-making
• Increase utilization of preventative care services
• Promote timely access to appropriate care to reduce emergency room utilization and hospital readmissions
• Increase continuity of care by managing relationships with tertiary care providers, transitions-in-care, and referrals
• Work with internal providers on coordinating schedules, getting a client in to other service lines as needed
• Facilitate patient access to appropriate medical and specialty providers
• Assist with the identification of “high-risk” patients with a chronic illness and coordinate care
• Assess for social drivers of health and work with Community Health Workers on integrated Care Management
• Attend all Care Management training courses/webinars and meetings
• Participate in quality improvement efforts by utilizing dashboards, tracking tools and providing quality reporting data monthly
• Follow protocols, clinical policy and procedure in collaboration with the Primary Care Provider/Specialty Care provider
• Perform in-clinic triage and medication refills
• Conduct nursing assessments according to assessment tools to determine services and service level of care needed
• Under provider direction perform and/or assist in inductions utilizing COWS, administer patient injections and provide education on naloxone
• Provide education about Neonatal Abstinence syndrome, support systems, and concerns
• Monitor medication adherence and check PDMP

RN Care Manager