GENERAL SUMMARY:
Develops, implements, monitors and evaluates a program of care for a unique patient population. This position works collaboratively with interdisciplinary staff internal and external to the organization to ensure quality patient outcomes, appropriate utilization of health care resources and effective communication and care across the continuum. Collaborates in the development, implementation and evaluation of guidelines and protocols from an integrated health system approach. Participates in the development and implementation of prevention initiatives and community outreach programs.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

+ Orients and educates patients and their families to the care plan, providing educational information in conjunction with direct care providers related to treatments, procedures, medication and continuing care requirements.

+ Develops interdisciplinary care plan by participating in meetings, coordinating care req...