LPN Care Coordinator
Posted on May 13, 2020 by Premier Physicians Centers
LPN Care Coordinator is responsible for assisting with patient care coordination and helping manage both data ingestion and data usage. This individual will work closely with the Healthcare Data Analyst to ensure proper workflow for the Clinical Integration & Utilization Management Department. Under the direction of a Registered Nurse, the Care Coordinator utilizes clinical and administration skills to ensure appropriate care transition and care management services are provided to patients, along with excellent care. Committed to the continuous improvement of the patient experience, which includes patient safety, quality of care, and excellent service.
- Makes transition calls to discharged patients daily within the designated time frames and documents and tracks findings.
- Initiates or accepts referrals from staff for patient needs assessment, determines eligibility for resource assistance, and makes resource referrals.
- Contacts patients for transition of care or follow up care, assesses their needs, identifies gaps in care.
- Assists care transition/management as needed with other job duties to ensure smooth functioning of the department.
- Works closely with physicians, nurses and other medical staff to communicate a patient's needs and concerns.
- Assesses for potential barriers and provides resources or referrals as needed.
- Reviews hospital discharge information, assesses patient understanding, and provides education as needed. Follows up with patients to assure their needs are still being met after discharge.
- Identifies patients that may need care management services.
- Uses clinical judgment, critical thinking and problem-solving techniques when assessing patients in order to promote optimum patient outcomes and decrease potentially preventable ED visits or hospital admissions/readmissions.
- Actively participates as a member of a patient-focused interdisciplinary care team.
- Sends referrals as needed and monitors for responses.
- Under the supervision of a Registered Nurse, provides care management for a diverse population of persons with chronic illnesses or disabilities of all types.
- Educates patients on disease processes, health maintenance, medication management and self-management skills.
- Makes outreach calls to care managed patients.
- Assists with care management according to knowledge base; collaborates with team members as needed.
- Assists with the edit, update and renewal of care plans.
- Utilizes a positive proactive approach to function as a health advocate to engage patients.
- Interacts with the care team on challenging cases.
- Monitors ED visits, inpatient, and skilled nursing facility discharges and notifies appropriate team members.
- Minimum level of education desired for candidates in this position is an LPN.
- At least two years of experience required.
- Experience working with individuals of different age spans, either in a home health care, medical, or behavioral health environment is required. Physical disabilities and behavioral health experience preferred.
- Demonstrates excellent written, verbal, telephonic, interpersonal and listening communications skills; positive relationship building.
- Ability to work independently under general instructions, self-directed and motivated.
- Demonstrates ability to work as part of a team.
- Excellent verbal and written interviewing and assessment skills.
- Knowledge of major chronic disabling illnesses for persons of all ages, disease processes, and normal aging.
- Experience with Microsoft Office, proficient typing skills with the ability to navigate a Windows environment.