Patient Care Coordinator LPN (100% Full Time, Days)- Family Medicine Woodlands Clinic
- Chillicothe, OH
- Permanent
- Full-time
- Maintain accurate and risk-stratified patient panels for each provider or care team serving as office extension to the current population health team.
- Serve as an in-office coordinator to align the needs of the patient with appropriate member of the care team: physicians, CNPs, nurses, MAs, nutritionists, pharmacy, diabetes educators, social workers, etc.
- Identify support systems and community resources for all patients regardless of payer when appropriate.
- Create care plans for all high-risk patients regardless of payer type.
- Identify and close care gaps by scheduling needed appointments, creating actionable telephone notes, and utilizing standing orders across multiple diagnostic categories.
- Review notifications of possible non-adherence and care gaps from pharmacies/insurers and create actionable telephone notes to send to the provider when appropriate.
- Identify missed and overdue office visit appointments, including wellness visits, and then coordinate the appropriate scheduling of these appointments.
- Meet with the patient in office at the time of provider appointment when appropriate and when requested by provider.
- Perform pre-visit planning for appropriate patients and update electronic medical record as needed.
- Ensure patients discharged from target hospitals are contacted within two (2) business days from time of discharge per CPC+ guidelines.
- Graduate of an Accredited Program in Practical Nursing
- LPN-Licensed Practical Nurse in the state of Ohio
- 1-2 year's experience in a similar capacity/setting