POSITION SUMMARY
The LPN Care Coordinator serves as a liaison between the patient and providers. They perform regular updates on patient well-being, develop treatment plans, communicate diagnoses and care plans, and evaluate recovery processes. Their primary goal is to improve patient outcomes by ensuring patients understand their conditions and treatments.
DUTIES & ESSENTIAL JOB FUNCTIONS
Coordinate care for assigned panel patients, including follow-up after hospital transitions, with responsibilities such as:
Obtaining daily admission/discharge lists using My Patient Your Patient Software and coordinating with GHP Case Managers.
Calling discharged patients within 48 hours to collect symptom and medication information.
Scheduling follow-up visits with the Primary Care Provider-Team within 2-7 days post-discharge based on patient needs.
Manage care for medium to high-risk patients, including:
Running high-risk stratification tools monthly and reviewing lists with providers.
Coordinating care for at least 30 high-risk patients.
Gathering and documenting patient data on vital signs, symptoms, safety, and socioeconomic factors.
Reviewing and documenting education plans and assisting with self-management goal setting.
Bill charges daily per procedure, participate in weekly huddles, attend monthly meetings, and manage at least 30 TOC cases.
Participate in extended hours, cross-coverage, and support other locations as needed.
Understand insurance dynamics to assist patients and engage at least 30 patients monthly in the Chronic Care Management Program.
Reconcile hospital admissions/discharges daily, maintain certifications, and stay compliant with training and competencies.
Ensure compliance with safety and emergency protocols, and complete assigned clinical procedures such as IV rehydration, INR monitoring, immunizations, lab draws, insulin pump management, blood pressure monitoring, and PPD readings.
Triages patient calls, monitors lab and referral statuses, and ensures timely documentation and follow-up.
Oversee Resident training and evaluations, coordinate supplies, and support Resident integration into clinical workflows.
Manage panel quality assurance, train staff, uphold HIPAA confidentiality, and participate in continuing education.
Serve as a clinical resource, ensure patient understanding of resources, and promote programs like sliding fee, GFE, outreach, language services, and after-hours coverage.
REQUIRED QUALIFICATIONS
Meet The Wright Center’s EOS People Analyzer criteria.
Experience with the EOS model (preferred).
Professionalism and organizational pride.
Graduate of an accredited LPN program and active Pennsylvania license.
BLS certification.
Experience with electronic health records, Medent preferred.
Strong teamwork and communication skills.
Commitment to quality and process improvement.