LPN Post Acute Care Coordinator

Description

PeaceHealth is seeking a LPN Post Acute Care Coordinator for a Full Time, 1.00 FTE, Day position. Hourly compensation starts at $24.76, more depending on experience.

Must be fully vaccinated for COVID-19 including 2 doses of a 2-dose series or 1 dose of a 1-dose series plus 14 days beyond the final dose prior to start date.

JOB SUMMARY

Coordinates integrated care delivery across the care continuum to improve clinical outcome, reduce readmission risk and promote effective utilization of health care resources for patients within the Clinically Integrated Network (CIN). Serves as a patient liaison to assist in a seamless transition between care settings and post-acute services.

ESSENTIAL FUNCTIONS

• Works with discharge planners and coordinates transitions of care, arranging warm handoffs between the clinics, hospitals, emergency departments and/or post-acute services. Facilitates the sharing of information across people, functions, and sites.
• Follows patients through the continuum of care in collaboration with key stakeholders in the treatment plans. Assures patients receive appropriate and timely services by making referrals and motivating/teaching patients to seek care.
• Participates in multi-disciplinary care conferences helping to ensure concise patient summaries are in plan and assists with coordination of the identified follow up plan.
• Conducts home and/or facility visits to conduct health screenings per established protocols, ensure patient understanding of care plan, resolves patient inquires within scope, and escalates patient inquiries beyond scope to either the RN, Clinic leadership, or provider.
• Collaborates and communicates information to and from patients, pharmacies, and other providers as directed and supervised by a licensed provider with other members of the interdisciplinary team to assure appropriate and smooth flow of care/services through the care continuum.
• Under Care Manager supervision, case manages a panel of patients, including implementing action plans and utilizing tracking tools, coaching for activation, providing education, patient/family support and coordinating with other care providers and resources.
• Coordinates and integrates care of selected populations by managing chronic disease registries and conducting outreach using various program delivery methods. May evaluate reports and act on outlier data based on criteria set forth by clinical council, or appropriate regional disease management program and/or performance improvement committee(s).
• Facilitates the coordinated utilization of resources for maximization of health outcomes, patient/family satisfaction.
• Perform other duties as assigned.

QUALIFICATIONS

EDUCATION:

• Graduate of an accredited State Board of Nursing LPN program.

EXPERIENCE/TRAINING:

• Minimum two years of clinical experience required. LPN experience strongly preferred.
• Demonstrated knowledge of and ability to apply age specific principles of growth and development and life stages to meet each patient’s needs.
• Comprehensive knowledge of care delivery systems across a wide variety of care settings including hospital, clinic, home care or nursing home.

LICENSE/CERTIFICATION:

• Current licensure as an LPN in the state in which nurse will be practicing.
• Current BLS (Basic Life Support) certification required at date of hire.
• Valid driver’s license (OR, WA or AK as applicable) and proof of auto insurance.

OTHER SKILLS:

• Ability to care for patients in a wide variety of environments
• Ability to collaborate with other multi-disciplinary team members.
• Proficiency in the use of computer and office equipment.
• Strong interpersonal and communication skills including basic understanding of motivational interviewing techniques.
• Strong verbal and written communication skills.
• Ability to adhere to quality, safety and infection control standards.
• Ability to manage personal growth, taking initiative to meet challenges within the team care environment.

PHMG PHYSICAL/COGNITIVE REQUIREMENTS

• Work requires normal amounts of physical effort up to 33% of the time
• Ability to lift objects weighing 30 lbs. or less.
• Work is performed under normal working conditions with adequate lighting and ventilation.
• Duties require the ability to concentrate and pay close attention to detail (more than 65% of work time)

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.