LPN | Primary Care Clinic

Hillsdale Hospital; Hillsdale (MI); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Paid Time Off

403(b) with match

Education assistance & continuing教育

Job summary

Hillsdale Hospital in Hillsdale, MI seeks an LPN with experience in chronic disease care to coordinate patient care and support self-management. You will work with patients and families to navigate the healthcare continuum and connect resources.

The role emphasizes effective communication, health IT proficiency, and collaboration with care teams, PCPs, and specialists to improve outcomes and access to services at on-site facilities.

Qualifications

• Current Michigan licensure as an LPN.
• Experience in caring for patients with chronic diseases is required.
• Ability to identify and implement appropriate patient communication strategies and overcome accessibility barriers.

Responsibilities

• Provide a coordinated approach to detect and manage chronically or mentally fragile patients' unmet health and social needs.
• Guide patients and families toward an effective plan of care.
• Improve health literacy through effective communications with patients and families.
• Coach patients toward successful self-management of chronic disease.

Skills

LPN licensure

Chronic disease care

Patient communication

Health IT familiarity

Data reporting

Education

High School or better

Tools

Health IT systems

ERMs

Job description

Hillsdale Hospital
168 S Howell St
Hillsdale, MI 49242, USA

Description

Work Schedule:

0800 to 16:30 Monday through Friday

• Paid Time Off: vacation, holidays
• Retirement: 403(b) with match
• Education assistance & continuing education; many courses offered on-site at the hospital

Qualifications:

• Current Michigan licensure as an LPN
• Experience in caring for patients with chronic diseases is required
• Ability to identify and implement appropriate patient communication strategies and overcome accessibility barriers if needed
• Previous experience with mobilizing community resources, navigating patients through the healthcare continuum, and working with disparate populations preferred
• Prefer experience in clinical or community health, care coordination, case management, home health or behavioral health
• Must be proficient in communication and computer technologies (email, cell phone, etc.)
• Previous experience with health IT systems, ERMs and data reports

Responsibilities:

• Provides a coordinated, strategic approach to detect early, assess, and manage effectively the chronically and/or mentally fragile patient population's unmet health and social needs
• Utilizes tools and documents that support a guided care process, collaborating with patient/family toward an effective plan of care
• Provides effective communications to improve health literacy for patients/families
• Coaches patients/families towards successful self-management of their chronic disease
• Acts as liaison between PCP and Specialists on patient condition as needed between office visits
• Develops a care plan based on mutual goals with the patient, family, and provider's emergency plan, medical summary, and ongoing action plan
• Monitors patient adherence to plan of care and progress toward goals, and facilitates changes as needed
• Promotes healthy behaviors in all populations and ensures navigation assistance with community resources
• Assists in outreach to patients made after they have been seen in ED or inpatient stay
• Facilitates patient access to appropriate medical and specialty providers as well as other care coordination team support specialists (e.g., Diabetes Educator)
• Cultivates and supports primary care and subspecialty co-management with timely communication, inquiry, follow-up, and integration of information into the care plan regarding transitions-in-care and referrals
• Serves as the contact-point, advocate, and informational resource for patient, family, care team, payers, and community resources
• Enrolls patient in Medicaid and assists with other community resource referrals
• Ensures effective tracking of test results, medication management, and adherence to follow-up appointments
• Facilitates and attends meetings between patient, families, care team, payers, and community resources
• Ensures all VBR and MSSP metrics are met
• Assists with VFC (Vaccines for Children) immunization programming at current Primary Care sites

Equal Opportunity Employer

Qualifications

Education

Required

High School or better.

Licenses & Certifications

Required

Licensed Practical Nurse

Equal Opportunity Employer
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