We are excited to welcome Jean Meister to our team and also a new role to assist our community’s health. You may receive a call from Jean Meister as a followup or to assist you in planning care for a loved one. This team approach to one’s care pulls together information to best assist patients.

Our Care Coordinator works in collaboration with patients, especially those that are chronically ill, and patients who are at high risk for decline, their family, caregivers, clinic staff, physicians, hospital, specialty providers, and community resources in a team approach to:

• Promote timely access to appropriate care
• Assess health and social needs
• Develop a care plan in collaboration with the patient, family, caregivers, and providers
• Monitor adherence to the care plan, evaluate effectiveness, monitor patient progress, and facilitate changes as needed
• Facilitate patient access to appropriate medical and specialty providers
• Educate the patient about relevant community resources
• Serve as contact point for patients between primary care and specialty services to facilitate timely communication, follow-up, and transitions in care for the patient
• Follow up with patients when dismissed from the hospital or emergency room to assess needs and progress of their health condition
• Complete Annual Medicare Wellness Visits to gather information, and organize in order to recommend proper preventative care and screening for optimal health of Medicare beneficiaries