• Collaborating with company providers and their family members to develop complex plans of care in accordance with the patient’s health status and overall goals and values • Provides clinical and non-clinical support to patients presenting with acute care needs virtually • Provides urgent health care via telephone and tele video modalities to patients who receive home and community-based services • Develops and implements clinical plans of care for adult patients facing chronic and complex conditions • Gathers history and physical exam and diagnostics as needed, and then develops and implements treatment plans • Identifies and closes gaps in care • Meets the patient’s and family’s physical and psychosocial needs • Educates patients and families about medication usage, side effects, illness progression, diet and nutrition, medical adherence and crisis anticipation and prevention • Maintains patient medical records and medical documentation consistent with state regulations and company standards and policy • Participates in continuing education as required by state and certifying body • Prescribes medication as permitted by state prescribing authority