Complex Care Manager
About The Position
The Lead Complex Care & Community Health Programs coordinates care for an assigned population of patients with complex care needs across the continuum of care. The role assesses care plans and evaluates outcomes in collaboration with the interdisciplinary healthcare team, guiding team members to support timely, safe, high-quality, and cost-effective care and transitions. The position monitors plans of care with patients and families and incorporates their input to evaluate care effectiveness, while supporting departmental and organizational initiatives as needed. Alongside clinical case management, the role provides leadership and operational oversight of the Community Health Worker (CHW) Program. This includes program development, workflow design, quality improvement, reporting, coordination with Epic and Information Services, and direct supervision of Community Health Workers. The position also chairs the Complex Care Committee and collaborates with interdisciplinary teams to improve patient outcomes, care transitions, and operational effectiveness.
Responsibilities
- Coordinate care across the continuum for an assigned population of patients with complex care needs.
- Assess care plans and evaluate outcomes in collaboration with the interdisciplinary healthcare team.
- Guide and collaborate with healthcare team members to support timely, safe, high-quality, and cost-effective care.
- Facilitate safe transitions of care.
- Monitor plans of care with patients and families and incorporate their input when evaluating care effectiveness.
- Support departmental and organizational initiatives as needed.
- Provide leadership and operational oversight of the Community Health Worker (CHW) Program.
- Lead CHW program development, workflow design, quality improvement, and reporting.
- Coordinate CHW-related work with Epic and Information Services.
- Directly supervise Community Health Workers.
- Chair the Complex Care Committee.
- Collaborate with interdisciplinary teams to improve patient outcomes, care transitions, and operational effectiveness.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
