Key services include screening for post-acute needs; transition planning; care coordination; education; community care referrals; care planning in accordance with regulatory requirements; collaboration with the continuum care team; ongoing monitoring of plan effectiveness and reassessment of the need for Care Management (CM) services. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.