Major/Essential Functions

Employees in this position are members of the TTUHSC SON Combest Interprofessional Collaborative Practice (IPCP) team. The employees will perform advanced, specialized work in community outreach, behavioral health and chronic disease management in vulnerable health populations. The major essential functions include:

Will establish close working relationships with patients and members of an interprofessional team to identify non-medical drivers of health and reduce health disparities.

Promote goal setting and strategic planning for the betterment of overall wellness.

Accepts referrals and provides case management for Children and Pregnant Women (CPW), and chronic disease management for IPCP.

Assesses healthcare needs to provide care coordination, tailored health educ and identifies community resources.

Serves as patient advocate and assists in identification and improvement of service delivery requiring exp...