Case management of clients' care

Coordinate and facilitate clients' care through assessment, evaluation, planning, and implementation.

Work collaboratively with clients, families, doctors, pharmacists, and nurses to ensure high-quality care

Communicate client needs to a variety of care team members and follow up accordingly

Available for weekly and monthly in-person and telephonic visits to continuously assess, plan and review client goals and strategies

Advocate for patient's health

Act as the client's advocate as it relates to insurance coverage and financial assistance

Provide Health education on chronic conditions, diet, and medication management

Reconciliation of medications with health providers/pharmacist

Liaison for family members on clients' doctor's appointments

Assist with discharge planning from the hospital/Rehab Facility to the community