Sentara Lpn Care Coordinator (3654

Job Details

Job Location:

Petersburg, VA 23805. Position Type:
Full Time. Salary Range: $22.55 - $28.67 Hourly.

• Patient care coordinators are liaisons between patients and the healthcare system. As a patient care coordinator, you would ensure that patients receive the care they need and that they understand their medical condition, medications, and other instructions.
• Identify high‑risk individuals by working with and while supporting Sentra’s insurance plan and via CVHS electronic record/practice management information.
• Perform regular outreach based on the patient’s personal preference, which could include email (if secure) or phone calls.
• Assist Sentara’s identified cohorts of patients through the healthcare system by acting as a patient advocate and navigator.
• Work closely with the Case Manager, Patient Educator, and others who assess the patient, to coordinate patient’s care and establish a plan of care.
• Support patient self‑management of disease and behavior modification interventions.
• Coordinate continuity of patient care with external healthcare organizations and facilities, by assuring all patient records are submitted to the Primary Care Provider.
• Help to manage high‑risk patient care, including patients with co‑morbidities or high risk for readmission to a hospital setting, including a registry.
• Promote clear communication amongst a care team and treating clinicians by ensuring awareness regarding patient care plans.
• Participate on a team for data collection, health outcomes reporting, clinical audits, and programmatic evaluation related to the Patient‑Centered‑Medical Home model.
• Customize care plans to meet the individual patient’s needs, prioritizing goals for patient’s health status; establish time frames for re‑evaluation; identify resources to be utilized, including the appropriate level of care; plan for continuity of care, including transition of care; identify collaborative approaches to be used, including family participation.
• Work with the patient, their family and/or caregivers to identify self‑management support.
• Effectively research and resolve prescription processing rejections to ensure patients receive medications within established patient service standards.
• Work closely with other pharmacy teammates to ensure all orders are received and processed timely and accurately.
• Receive calls from patients and answer questions regarding prescription status, reimbursement, co‑payment assistance, health plan drug coverage, and other related questions.
• Maintain patient database information including personal, physician, prescription, insurance, agency, financial assistance and related data.
• Work in a hybrid capacity with scheduled coverage at the mobile health unit 2–3 days per week.
• Participate in Quality Assessment.
• Participate in Clinical Collaboratives.
• Document each patient encounter in the electronic health record.
• Support a team‑based approach to patient‑centered medical care.
• Attend work as scheduled.
• Managers may modify, add or remove essential job functions as necessary, or as changing organizational needs require.
• Complete annual competencies for current position, basic hands‑on nursing skills for patient care.
• Attend annual skills day offered for nursing staff.
• Assist with patient care within the site in the event of a catastrophic nursing shortage and when all other resources have been utilized.
• Perform other duties as assigned.

• Demonstrate competence in performing essential duties.
• Ability to plan.
• Concern for patient confidentiality.
• Show initiative and use sound judgment in the absence of specific orders.
• Be resourceful.
• Act as a patient advocate.

• Graduate of accredited school of nursing, licensed by the Virginia State Board of Nursing, or from a compact state.
• Data entry, retrieval and report generation experience.
• Required:
  
  3 years in office clinical experience.