Christus Health – Irving, TX – DESCRIPTION SUMMARY: Provides care under the direct supervision of the Population Health Director of Care Management or Nurse Manager utilizing physician approved patient protocols according to established standards and best practice guidelines.Facilitates the communication between patient/caregiver, physician and the outpatient care team to optimize health and wellness, reduce inpatient admission, reduce re-admissions and improve medical stability in the patient population served.Works… collaboratively with Nurse Navigators to manage medical stability in patients with high risk disease management with complex comorbid conditions Manages a case load of 10,000-15,000 patients with identified gaps in care in collaboration with the Health Care Team. * Works in collaboration with the PCMH Team in the design, implementation and evaluation of the PMH model as applicable. * Works proactively to coordinate preventative/follow-up care for all patients receiving care from participating providers…