Licensed Practical Nurse- Care Coordinator

Valley Health; Winchester, Northern (VA, KY); Hybrid; USD 32,000 - 47,000; Full time

Job summary

Valley Health is seeking a licensed practical nurse (LPN) for a Population Health Care Coordinator role in Virginia. You will support outpatient care coordination, educate patients on disease management, and connect them with community resources.

You will maintain EMR records, participate in team meetings, and mentor peers as part of a growing population health team. Responsibilities include managing a patient panel, weekly follow-ups for high-risk patients, and collaboration with RN Care

Qualifications

• Outpatient experience preferred.
• Knowledge of medical terminology.
• Ability to work in a multidisciplinary team.
• Proficient with Microsoft Office.
• Valid driver’s license and ability to travel.
• Knowledge of funding/resources and patient navigation.
• Excellent communication and interpersonal skills.
• Understanding of patient education and care coordination.

Responsibilities

• Collaborate with RN Care Coordinator to manage a patient panel up to 250.
• Educate patients on disease management per best practice standards.
• Identify patients needing closer follow up and escalate when needed.
• Connect patients with resources based on program eligibility.
• Implement care plan and monitor progress with patient/family.
• Maintain EMR documentation and billing per care plan.
• Perform weekly follow-up calls for high-risk post-discharge patients.
• Serve as liaison to providers, patients and families for services.
• Review utilization and quality reports to identify gaps in care.
• Participate in team meetings, committees, and training; mentor peers.

Skills

Outpatient advocacy

Medical terminology

Multidisciplinary teamwork

Microsoft Office

Driver's license

Travel readiness

Communication skills

Population health knowledge

Education

High School Diploma

LPN License

Tools

Microsoft Office

Job description

As one of the nation's Top 15 Health Systems, recognized by Premier and Modern Healthcare, Valley Health is a place where excellence, compassion, and purpose come together. This distinction reflects our commitment to exceptional patient care, clinical quality, and the caregivers who make it all possible.

Department VALLEY PARTNERS LLC - 838376 Worker Sub Type Regular Work Shift Pay Range $22.71 - $34.06

Job Description

• Collaborate with RN Care Coordinator to manage a patient panel of up to 250.
• Perform periodic holistic care management based on initial assessment and goals as outlined by RN Care Coordinator. Provide education regarding disease management based on current best practice standards. Identify patients who may need closer follow up and elevate care to RN Care Coordinator as appropriate for re-evaluation and triage.
• Knowledge of current federal, state, and local programs as well as their eligibility requirements and application process in order to pro-actively connect patients with appropriate resources.
• Implement care management plan and goals established by RN Care Coordinator and mutually agreed upon by patient/family. Utilize motivational interviewing techniques and assist patient in meeting action-oriented goals and objectives.
• Evaluate effectiveness of plan in meeting established care goals. Collaborate with RN Care Coordinator in instances where goals may need to be revised.
• Interacts professionally with patient/family to achieve maximum levels of wellness and independence.
• Perform weekly follow up calls for patients recently discharged from the hospital who are considered high risk for readmission until patient has been discharged for 30 days. Ensure that the patient has attended follow up appointments as scheduled and is adherent to medications. Provide patient with education regarding hospital diagnosis. Identify patients who have had a change in condition and elevate care to RN Care Coordinator for further evaluation/triage.
• Serve as liaison to providers, patients and families for coordination of services.
• Maintains EMR databases on care managed population. Maintain accurate and timely documentation and billing based on care plan initiated by RN Care Coordinator. Identify patients who have had a change in condition and elevate care to RN Care Coordinator for review of care plan.
• Review utilization and quality reports routinely, scan for gaps in care and identify patients needing the additional support of care management.
• Participates in regular team meetings. Participates in departmental and organizational committees as applicable. Participates in the orientation of new personnel. Precepts and acts as a mentor to peers. Promotes collaborative teamwork.
• Meet with RN Care Coordinator team lead and Manager Population Health Outpatient Care Coordinator on a regular basis to provide patient updates, identify issues, and develop strategies for resolution.
• Performs all duties and responsibilities in accordance with basic principles and guidelines of professional nursing. Ensures documentation meets current standards and policies.
• Attend conferences, workshops, and complete continuing education as assigned.

Education

High School Diploma required

Certification & Licensures

LPN License required. Based on primary state of residency and in accordance with current Virginia Board of Nursing Regulations, must be licensed or eligible to practice pending licensure as a Licensed Practical Nurse in the Commonwealth of Virginia and/or West Virginia (as applicable depending upon geographical area assigned) with either a: Multi-State License, under the Nurse Licensure Compact required. BLS Certification (Basic Life Support) - American Heart ‘Healthcare Provider’ (HCP) - AHA approved required. New hires must have American Heart Association (AHA) appropriate certification prior to completion of orientation.

Qualifications

• Experience in an outpatient setting as an advocate role for a community health services position preferred
• Basic knowledge of medical terminology preferred
• Ability to interact with other professionals as part of a multidisciplinary team
• Experience with word processing package such as Microsoft Office desirable
• Valid driver's license based on primary state of residency
• Ability to travel to meet with clients/attend business functions/trainings/meetings at all VH work sites required
• Knowledgeable in the cognitive, physical, emotional, and chronological stages of human growth and development required
• Communicates effectively and works cooperatively with others required
• Knowledge of funding, resources, clinical standards and outcomes for population required

FLSA Classification

FLSA Classification Exempt Physical Demands 20 A Nursing, Certified Nursing Assistants (CNA), Patient Care Tech.

Benefits

At Valley Health, we believe everyone is a caregiver, and our goal is to create an environment where our caregivers thrive physically, financially, and emotionally. In addition to a competitive salary, our most popular benefits for full-time employees include: A Zero-Deductible Health Plan Dental and vision insurance Generous Paid Time Off Tuition Assistance Retirement Savings Match A Robust Employee Assistance Program to help with many aspects of emotional wellbeing Membership to Healthy U: An Incentive-Based Wellness Program Valley Health also offers a health savings account & flexible spending account for childcare, life insurance, short-term and long-term disability, and professional development.

• A Zero-Deductible Health Plan Dental and vision insurance Generous Paid Time Off Tuition Assistance Retirement Savings Match A Robust Employee Assistance Program to help with many aspects of emotional wellbeing Membership to Healthy U: An Incentive-Based Wellness Program Valley Health also offers a health savings account & flexible spending account for childcare, life insurance, short-term and long-term disability, and professional development.

Our Growth is Creating Great Opportunities! Our team is expanding, and we want to hire the most talented people we can. Continued success depends on it!