LPN Care Coordinator

Company: Christ Community Health Services
Location: Raleigh
Posted on: September 15, 2020

Job Description:

ApplyDescriptionJOB DESCRIPTIONTitle: LPN Care CoordinatorLocation: RaleighDepartment: Medical OperationsSupervisor: Site ManagerStatus: non-exempt full-timePOSITION SUMMARYThe Care Coordinator Nurse serves as an essential addition to the Medical Home Care Team by coordinating the care of patients and navigating patients through systems to improve health.KEY RESPONSIBILITIES* Participate as a valued member of the PCMH Care Team to oversee the coordination of patients and PCMH as a whole.* Use stratification tool to identify patients appropriate for care coordination.* Prepare handoff tool that identifies patient gaps that need to be closed* Review medical records to ensure completeness prior to patient exam, obtaining missing documentation, lab reports, and consultation results. Documents clinic visits, observations, and related activities. Prepares and maintains required reports, records and files.* Coordinate the scheduling and referral of patients for specific treatments, procedures, home health services, and hospital admissions* Engage with recent hospital discharges to get appointments scheduled* Track referral reports* Conduct holistic assessments during patient visits to assess the needs and goals of patients and also alert other care team members about patient needs.* Develop and maintain individualized and proactive care plans for care coordination population* Works with care team to focus on disease-specific self-management and medication adherence, while providing support, information and education for specific diseases* Provide communication and support to the providers on all assigned cases* Navigate patients through systems and across transitions* Contact patients appearing on registries and in need of treatment and/or follow-up* Connect patients to community resources as needed* Document data and interactions with patients in electronic medical records* Instruct individuals, families, or other members of the patient's care team on health education, disease prevention, or community resources.* Collaborate with other care team members to proactively perform care coordination for patients that are enrolled in care coordination* Communicate patient concerns that need to be addressed during Huddle with Team Nurse* Assist with the completion of tasks assigned to the care team from the EHR such as prescription refills or communication of lab results.* Provides patient education* Responds to patient telephone calls* Assist care management patient with achieving set goals by implementing relevant nursing interventions* Assists patients in care coordination with scheduling appointments with specialists.* Conducts clinical follow-up calls* Monitors the quality of patient care.* Provides back up to support patient care functions* Attend weekly care coordination meeting with RN* Performs other clinical duties as neededRequirementsPOSITION REQUIREMENTSEducation: school diploma, or equivalent; completed licensed practical nursing programExperience: prefer 2 years of care managementLicenses/certifications: LPN with active TN licenseMental capacity:LEVEL3=requires intermittent high concentration and high attention; generally, task approach is consistent, but number of steps/variables create causes-for-error without close attentionPhysical capacity:Sitting 20%, Standing 30%, and Walking 50% of timeLifting, pushing, or pulling 5% of time; max 50lbs of papers or suppliesMachines/equipment (hand/eye coordination):Computer--variable% of time (normal)Phone--variable% of time (normal)Copier/fax--variable% of time (normal)On-the-job travel:3% of time traveling, excluding regular commute to primary location(s)WORKING CONDITIONSMedical clinic setting with ongoing exposure to contagious individuals and infectious disease; requires universal precautions; some exposure to varying weather conditions when traveling between work locations

Keywords: Christ Community Health Services, Raleigh , LPN Care Coordinator, Healthcare , Raleigh, North Carolina