LVN Clinical Care Coordinator

Job Description

If interested, please apply and send your resume to yadeleon@mlkch.org.

POSITION SUMMARY

MLK Community Healthcare is seeking a Licensed Vocational Nurse (LVN) Coordinator to be part of our Care Management program. The LVN Coordinator will coordinate care for patients enrolled in Enhanced Care Management (ECM) and Disease Management programs. The LVN Coordinator will be an active member of the interdisciplinary care team meetings to discuss medication management/adherence and ensure appropriate follow-up with the primary care provider, behavioral health provider, and other specialist(s). Conducts nursing assessments, behavioral health, and social service needs, developing care plans, coordinating care, and working with the team’s medical provider to support the patient’s health goals. This is a dynamic position that requires being self-led, clinical acumen, and patient engagement skills. The LVN Coordinator works with various partner organizations to provide transitional healthcare support. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Provides clinical assistance for ECM and Disease Management to address patients' medical and behavioral health needs. Participates in developing patient-centered care plans for the enrollees on their panel. 
• Evaluates needs and develops plans for the ECM and Disease Management members to receive needed services and measuring progress towards the goals outlined in their patient-centered care plan.
• Assists in identifying health care needs that focus on general health conditions, treatments, and interventions specific to each individual's health needs and consistent with standards of care.
• Actively identifies and addresses patient needs to close care gaps, facilitate timely follow-up appointments, and ensure comprehensive care coordination among healthcare providers.
• Actively consults with Care Managers to review medical visit summaries, discharge papers, prepare for upcoming appointments, or review appointment outcomes.
• Provide training support to staff on documentation standards, quality measure workflows, and EHR (Cerner) system utilization to ensure compliance and enhance operational efficiency.
• Engages vulnerable populations as part of a multidisciplinary outreach team. This includes home visits, accompaniment to appointments, outreach to hospitals, homeless shelters and other settings, as needed.
• Helps address Social Determinants of Health and enhances connections to community-based organizations.
• Works with hospitals to coordinate hospital admission/discharge plans with the behavioral health clinician, PCP, pertinent specialists, and other organizations to prevent readmission, if possible.
• Performs timely medication reconciliation following transitions in care. Supports medication adherence.
• Assists with billing submission.
• Assists with health plan chart audits.
• Travel to MLKCH ambulatory and administrative sites as needed to aid in patient care
• Other duties as assigned.

Job Requirements

POSITION REQUIREMENTS

A. Education

• High School graduate or GED.

B. Qualifications/Experience

• Minimum of one (1) year experience in a medical practice environment, healthcare and/or hospital or related field.
• Six (6) months of project coordination experience preferred.
• Valid unrestricted CA Driver’s License with proof of vehicle insurance. Must present both within 30 days of hire/transfer.
• Current Basic Life Support (BLS) for Health Care Providers from the American Heart Association.
• Current Licensed Vocational Nurse (LVN) state license
• Care Management experience (preferred)
• A team player that can follow a system and protocol to achieve a common goal
• Highly organized and well developed oral and written communication skills
• Confidence to communicate and outreach to other community health care organizations and personnel
• Demonstrates sound judgment, decision making and problem solving skills

C. Special Skills/Knowledge

• Relevant experience in understanding homelessness, and in promoting community relations (preferred) 
• Demonstrated ability in providing services for people experiencing homelessness (preferred) 
• Demonstrated ability to build consensus on strategies among peers to address homeless patients (preferred)
• Ability to effectively coordinate care with medical assistants and other support staff, encourage and nurture development and growth, to build a strong and productive team, preferred
• Commitment to the provision of primary care services for the underserved with demonstrated ability and sensitivity in working with a variety of people from low-income populations, with diverse educational, lifestyle, ethnic, and cultural origins 
• Strong organizational, administrative, and problem-solving skills and ability to be flexible and adaptive to change
• Ability to effectively present information to others, including other employees, community partners, and vendors
• Ability to seek direction/approval on essential matters yet work independently with little supervision, using professional judgment and diplomacy
• Work in a team-oriented environment with several professionals with different work styles and support needs
• Demonstrated ability to interact effectively with people on the streets and at all levels of the organization (preferred)
• Demonstrate ability to work with unsheltered homeless, their environment and their social issues (preferred)
• Ability to demonstrate knowledge of public health care systems (preferred)

#LI-YD1