OverviewProvides comprehensive care management and transition of care services within a multidisciplinary team to improve quality, reduce cost, promote optimal patient health and well-being across the continuum of care and promote patient and provider satisfaction. Utilizes data analytics, population health principles, and quality measures to facilitate delivery of high quality, cost effective, patient-centered, holistic care to optimize patients' health and health outcomes. Implements the case management process to assess, plan, implement, coordinate, monitor, and evaluate resources and services to promote optimal health and health outcomes of high risk, complex patients. Delegates care plan tasks to appropriate care team members. Collaborates with providers, p