Career Center

ESSENTIAL DUTIES, FUNCTIONS AND RESPONSIBILITIES: Develops and implements comprehensive care plans with patient, family, team (emergency plan, medical summary, and action plan as appropriate), and evaluates and continually monitors/updates/alters these plans based on patient/family needs and unmet needs, strengths, and assets. Coordinates inter-organizationally with family, Ambulatory Clinics, inpatient services, and involved services and agencies; facilitate "wrap around" meetings or team conferences and attend community meetings with family as necessary. Observes and assess health status of patients by physical assessment and examination, interviewing patient and family member, and reviewing patient's health history. Cultivates and suppo