Methodist Healthcare Ministries
San Antonio, TX, USA
Essential Duties: Works with Care Coordination RN/LVN to promote and reinforce patient centered medical home (PCMH) concepts with patients and staff. Coordinates care for designated patients by collaborating with MHM primary care providers, the integrated healthcare team, specialists, Clinical CHWs, Wesley Nurses, patients, and families to ensure seamless navigation through the healthcare system. Support patients in navigating follow-up care after an ER visit, including scheduling appointments, managing medication needs, and assisting in the coordination of specialty referrals to ensure effective care transitions. Follow established processes aimed to improve patient's health outcomes. Provide education to patients and/or family regarding patient's condition and ongoing care. Responds to inquiries and calls from patients, providers, integrated healthcare team and external resources. Assists in the resolution of complaints, requests, and inquiries from patients. Monitor...