LPN Care Coordinator – Spanish Speaking

This is a fully remote position, open to applicants in United States.

📋 Description

• The LPN Care Coordinator is tasked with providing Transitional Care and Chronic Care Management services to help patients flourish and achieve their desired outcomes.

• Key responsibilities encompass post-discharge patient engagement, the development of patient-centered care plans, and service coordination through software tools that enhance communication and information sharing with patients, CRC providers, and other members of the care team.

• Conduct a thorough review of EMR records to guide initial outreach and identify focus areas for care plans.

• Perform comprehensive evaluations considering both physical and psychosocial risk factors that align with individual patient needs while recognizing and addressing obstacles.

• Relay assessment results, care plan objectives, interventions, and outcomes to providers, patients, and caregivers promptly.

• Track patients' emergency department visits and acute hospital stays, conduct follow-up calls post-discharge, and continually evaluate the risk of readmissions after discharge.

• Employ motivational interviewing techniques to enhance patient engagement and empower them to cultivate self-management skills.

• Offer education on chronic diseases and symptom management to both patients and their caregivers.

• Communicate proactively with providers regarding any changes in patient status or to secure necessary referrals/orders.

• Record care plans, clinical interventions, and outreach efforts in the care management software system.

• Foster and maintain productive professional relationships with assigned providers and fellow care management team members.

⛳️ Requirements

• A high school diploma or equivalent is required.

• An Associate's or Bachelor's degree is preferred.

• Must be a Licensed LPN/LVN or Registered Nurse.

• Requires a minimum of two (2) years of experience in care coordination, particularly in post-discharge transitions of care.

• Experience in providing care coordination for a skilled nursing and/or Medicare beneficiary population is essential.

• Experience with transitions of care from Skilled Nursing Facilities (SNF) to home or coordinated care within SNF bundled payment systems is highly preferred.

• Familiarity and experience with electronic medical records (EMR) and Care Management technology are necessary.

• Capability to develop, prioritize, and achieve goals along with effective time management skills.

🏝️ Benefits

• Excellent health insurance options, including Medical, Vision, and Dental coverage.

• Short Term Disability, Life Insurance, and Critical Illness benefits.

• A generous PTO package along with time off on select holidays.

• Highly competitive salary accompanied by a generous bonus structure.

• A 401(k) plan with an annual contribution of 2-3%.