Community LPN

We’re unique.  You should be, too.

We’re changing lives every day.  For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts?  Do you inspire others with your kindness and joy?

We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

The Community Care team is a multidisciplinary service including Registered Nurse (RN) Community Care nurses, Licensed Practical Nurse (LPN) Community Care nurses, Community Social Workers and Community Health Coordinators, who work with our highest complexity patients and their primary care physicians, to meet their medical and social needs with the aims of fully engaging them in our intensive primary care model and maximizing their healthy time at home.
The Community Care Nurse, HCT (LPN) is a vital Community Care Team member who focuses on medical stabilization of our highest risk patients, typically in their homes but also during center visits and telephonic outreach. The incumbent will implement comprehensive care plans designed by our Nurse Case Managers to provide targeted education and deliver other care under the supervision of our RN community care nurses and/or primary care physicians. The incumbent establishes strong relationships with their patients, patients’ family members and caregivers, and other team members to achieve good understanding of the plans of care and achieve positive patient outcomes.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Under the direction and supervision of a Registered Nurse (RN) provides in home and telephonic visits to patients at high-risk for hospital admission and readmission (as identified by CM Plan).  Main goal to prevent and admission or readmission to the ER/hospital.
• While conducting a home visit or a center visit with our patient compiles patient health information, takes and records vital statistics, takes blood pressure and conducts other basic care treatments. Records patients’ medical history and other information such as test results in the medical record.
• Performs 4-day discharge phone call on patients discharged from a hospital, SNF, LTAC within 24-48 hours of discharge.
• With a physician order draws blood (phlebotomy) and collects other lab specimens.
• Using the medication list provided in our DASH system and approved by the physician to fill pill boxes for patients.
• Helps patients navigate health care systems, connecting them with community resources; orchestrates multiple facets of health care delivery and assists with administrative and logistical tasks.
• Assists patient and family with completion of Medicaid application for support and access to community/financial resources and refer cases to social worker as appropriate.
• Assesses the environment of care, e.g., safety and security, using our home safety evaluation form.
• Provides education with patient/family on different health concerns using standardize education directed by the Registered Nurse (RN).
• Coordinates the delivery of services to effectively address patient needs.
• Visits patient at home under the direction of the patient’s primary care physician to meet urgent patient needed.
• Performs other duties as assigned and modified at manager’s discretion.

KNOWLEDGE, SKILLS AND ABILITIES:

• Exceptional knowledge of medical products, terminology, services, standards, policies, and procedures.
• Ability to effectively collaborate with team members, including physicians, HCT team members such as Manager of Community, Registered Nurse (RN), Community Health Worker (CHW) market leaders, center managers and front desk team staff.
• Ability to exercise patience, compassion and empathy for patients and family members.
• Ability to act calmly in busy or stressful situations. Working with Registered Nurse (RN) on daily schedule which may change throughout the day for those patients with a greater need of a home visit. 
• Skill in operating phones, personal computer, software, and other IT systems. Must be detail-oriented to ensure accuracy of reports and data.
• Excellent clinical skills to identify, diagnose and appropriately resolve patient issues.
• Excellent oral and written communication skills
• Good time management to ensure tasks are completed timely and efficiently.
• Mindset focused on solving problems for patients and achieving team goals.
• Ability and willingness to travel locally and regionally up to 40% of the time.
• Good time management and organization
• Attention to details to be able to follow the Registered Nurse (RN) plan or care and education provided to the patient.
• Problem solving skills.
• Excellent teamwork and collaboration skills.
• Ability and willingness to travel locally to patient homes.
• Spoken and written fluency in English, Bilingual a plus.

EDUCATION AND EXPERIENCE CRITERIA:

• High school diploma or equivalent required.
• Graduation from a nationally accredited school for practical or vocational nursing required.
• Current, active LPN license to practice in state of employment required.
• CPR certification for Healthcare Providers required.
• A minimum of 1 year of work experience as an LPN required.
• A minimum of 3 years overall clinical experience is preferred.
• Experience working with geriatric patients is a plus.

Please respond to the following questions:

If this is a patient-facing role, does it require a BLS (Basic Life Support) Certification? yes

• If unsure, confirm with Managing Director, Clinical Operations

Will this role require an MVR as part of the background check? Yes

• If unsure, confirm with  Employee Relations

If this is a Finance role, will it require a credit check? No

• If unsure, confirm with Controller or Designee

If this is a Sales role, does it require disclosure and details of insurance sales license(s) at time of hire? No

• If unsure, confirm with Senior Director, Sales Operations