Care Coordinator-LPN - Infectious Disease

This position supports the Outpatient Paranteral Antibiotic Therapy (OPAT) program as well as the Infectious Disease clinic.

Provides care management for specific patient populations, utilizing clinical expertise, communication and problem solving skills to achieve optimal clinical and resource outcomes. Promotes cost-effective care by minimizing fragmentation, maximizing coordination and facilitating patient/family movement through the system. Applies protocols when appropriate and facilitates referrals, providing linkages to health and wellness resources across the health care continuum. Promotes interdisciplinary collaboration and teamwork to progress the plan of care. Must possess knowledge of growth and development appropriate to age group served and incorporate plan to meet needs into plan of care.

• Coordinates care and services within care managed population.
• Performs patient/family data collection to assist in identifying individualized care management needs.
• Using evidence based protocols, implements plan of care interventions as identified by the Care Team and communicates with clerical and clinical support staff to coordinate activities to meet care needs.
• Works with Care Team to identify individual care management needs. Huddles daily with Care Team for pre/post-visit planning to identify those patients who need close follow up, resources, additional education, and support.
• Documents needed interventions on provider's schedule ie necessary labs, patients in poor control or who may need intensive education in-house or through referral.
• Coordinates plan of care and services, directing liaison activities to appropriately integrate the patient into the health care continuum.
• Monitors plans of care/pathways/practice guidelines to ensure that expected patient outcomes are achieved within appropriate time frames and utilizing effective resources.
• Facilitates Interdisciplinary Team Meetings. Provides feedback to the health care team verbally or via chart entries related to the patient's progress toward reaching expected outcomes or about barriers to the plan. Coordinates changes to the plan as necessary.
• Documentation in the medical record is completed in the appropriate time frame and accurately reflects the plan of care and care management interventions planned or completed. Facilitates physician documentation of data that accurately reflects the patient's condition, co-morbidities, treatment and procedures that support the most appropriate status.

Education: Graduate of an accredited school of practical nursing.

Experience: Five years recent experience in a physician practice or clinic.

Licensure, certification, and/or registration: Current license to practice practical nursing (LPN) in the state of Virginia. AHA BLS-HCP required in practices where the Care Coordinator provides direct patient care. Case Management or Care Coordination Certification required within one year of hire.

Other Minimum Qualifications: Must demonstrate knowledge and competency in the following areas: positive interpersonal oral communication skills; effective written communication skills; analytic skills; team player; courteous; ability to resolve complaints/problems; customer-focused philosophy of service delivery; ability; willingness to work as an integral member of a multi-skilled team. Also demonstrate knowledge and competency in: computer literacy; community and system resources; effective interpersonal relations; analysis and research methods.

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