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Clinical Care Coordinator (LPN) - SHS in Philadelphia, PA at Public Health Management Corporation

Date Posted: 12/9/2018

Job Snapshot

Job Description

Responsibilities:

  • Clinical Care Coordinator is part of The Complex Chronic Care Management Team which works with patients and staff across the six PHMC health centers to help improve the care for identified at risk individuals with complex care needs.
  • Provides clinical support and direct care management including but not limited to patient assessments, health education, health screenings, and coordinates patient care
  • Records care provided within electronic medical record and completes other assigned reports.
  • Provides outreach in the way of phone call and face to face visits in the home.
  • Works with the Complex Care Management Team to develop individualized care plan for each patient which includes health conditions, treatments, behaviors, risks, support resources, values, preferences and overall needs to develop care plan then work with patient/caregiver/co-learner/providers to develop goals, informs care team if inappropriate for complex care and makes recommendations for care plan in usual care team.
  • Coordinate and manage member post-discharge activities and member home visits as needed.
  • Support the patients with pre-visit checklist process, including assisting the member in preparing for visit, reviewing health maintenance during their visit, placing orders in advance and completing visit follow-up work.
  • Works collaboratively with complex care team, patient provider, RN care manager, BHC and any other appropriate staff member.
  • Works within all state and federal laws and regulations.
  • Notifies immediate supervisor of significant problems.
  • Performs other tasks as directed and needed
  • Maintains positive relationships with funding sources and community organizations.
  • Performs other tasks as directed and needed.

 Skills:

  • Strong written and verbal communication skills
  • Ability to work with diverse staff and patients in an urban setting

  • Current CPR certification

  • Ability to maintain comprehensive, accurate and timely nursing documentation

  • Ability to travel within Philadelphia as needed
  • Experience with homeless people, and a diverse population
  • Case management experience preferred

 Education:

  • Associate Nursing Degree Required.
  • Pennsylvania LPN License Required

Salary: Based on education and experience.

  • Pay Grade 17