Summary: The LPN Care Coordinator is responsible for performing a wide variety of patient care activities to support a defined patient population, program and/or services. The LPN Care Coordinator will work within the scope of licensure to implement patient-specific interventions that include but are not limited to closing gaps in care, transition of care follow-up, health coaching, and promotion of effective utilization of services.

Principal Responsibilities:

1. Will participate and maintain a culture within The Corvallis Clinic that is consistent with the content outlined in the Service and Behavioral Standards document. To this end, employee will be expected to read, have familiarity, and embrace the principles contained within.

2. Telephonic outreach to patients, caregivers, and members of the patient's care team during post-acute care transition.

3. Performs medication reconciliation.

4. Proactive outreach to patients to ensure their healthcare goals are being met and care gaps are being addressed.

5. Enlisting a team approach by working collaboratively with the family, primary care provider and other members of the healthcare team to ensure coordination of services.

6. Assists patients with ongoing self-management goal setting utilizing Motivational Interviewing skills.

7. Facilitates follow-up appointments.

8. Facilitates access to community services.

9. Strong computer skills are necessary to be able to track patient’s adherence with their plan of care in electronic charts, as well as to utilize data reports from payers and registries to identify patients who need outreach services.

10. Attend staff meetings as required.

11. Maintain strictest confidentiality.

12. Perform other duties as assigned.

Education, Licensure and Experience:

1. Graduate of an accredited school of nursing required.

2. Current Oregon LPN license required.

3. Three (3) years of recent clinical LPN experience preferred. Fewer years of LPN experience combined with other/related healthcare experience will be considered.

4. Current Basic Life Support (BLS) certification or ability to complete BLS certification within 90 days of hire required.

Knowledge and Skills:

1. Nursing theory and practice to deliver patient care.

2. Chronic disease management with use of established protocols and nursing judgement.

3. Principles of health promotion/disease prevention.

4. Knowledge of chronic health conditions and their greater impact.

5. Ability to communicate effectively in both written and verbal formats.

6. Customer service skills and the ability to work well both independently and as a member of a multidisciplinary team.

7. Comfort and experience participating in a team-based model.

8. Community resources knowledge.

9. Ability to identify complex problems, review information, and navigate to reasonable solutions.

10. Experience with care coordination processes and motivational/health coaching with patients.

11. Counseling and a positive, enthusiastic, and helpful personality to provide excellent patient service.

12. Word processing, spreadsheets, and database applications

13. Developing and maintaining quality assurance as related to commercial and Medicare 5-star status.

14. Establishing and maintaining effective working relationships with patients, medical staff, and the public.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The noise level in the work environment is usually moderately quiet.

Exposed to patient and environmental conditions, and some unpleasant sights, smells, and contagious diseases.

Note:

This document is intended to describe the general nature and level of work performed. It is not intended to serve as an exhaustive list of all duties, skills, and responsibilities required of personnel so classified.

The Corvallis Clinic is an at-will employer. That means that either you or The Corvallis Clinic is free to end the employment relationship at any time, with or without notice or cause. And nothing in this job description or The Corvallis Clinic policies or procedures, either now or in the future, is intended to change the at-will nature of our relationship.

Employee signature below constitutes employee's understanding of the requirements, essential functions, and duties of the position. Employee agrees that they can perform the essential functions of the job with or without accommodation.