portals, and assists in managing transitions of care. The Medical Home LPN will act as a clinical liaison to the physician care plan and actively communicate with patients. The LPN participates in process improvements, is knowledgeable of clinical goals and outcomes including patient satisfaction and engagement.
Must have strong skills in clinical care, customer service, communication, and teamwork. Graduate of an approved technical, professional, or vocational program in Healthcare Healthcare clinical experience preferred physician practice or related field Medical office flow, especially the clerical/front office tasks Practice management software and medical coding/billing strongly
encouraged3-4 years experience Clinical Healthcare Coordinates the primary care rooming process, relevant medical procedures, adult and pediatric patient care including, immunizations, venipuncture, point of care testing, and performs retinal scan images.
Follows scheduling decision tree, protocols and policies for clinical procedures and appropriate use of medical equipment. Provides accurate and complete documentation of all facets of care including clinical calls, patient rooming questions, completion of procedures, order entry, prescriptions and patient shop, and workflows. Participates as a part of the patient centered medical home team during all patient visits by reviewing the
patient chart of clinical gaps in care. Assist with outreach campaigns and tactics to close gaps in care.
Supports and completes pre-visit planning and participates in daily huddles with the physician and care team. Understands population health and value-based contracts. Utilizes key quality and unitization metrics of value-based programs for both wellness and chronic disease management. Demonstrates abilities in the Primary Care quality program including all protocols of well and chronic disease states. Identifies patients " at risk" for change in condition and increased utilization. Attends required population health training and education such as Lunch and Learns and other opportunities Participates in the longitudinal care continuum of patients through completing post ED/post inpatient discharge outreach on identified risk patient group.
Updates care team thorough documentation and works collaboratively with Complex Care RN, Social Worker, CHW, and Population Health Pharmacist. Provides basic community resources to patients with social determinates in health. Diabetes Education, Colon Cancer Screening). Supports facilitating follow-up for post-hospital care, chronic disease management, or specialty referral. Age-related competencies, experience with multiple age groups, understanding of recommended screenings based on age groups, understanding of chronic disease management process, and experience with patient centered medical home.
At Tri Health, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. Refrain from using cell phones for personal reasons in public spaces or patient care areainteractioncel: ALWAYS… Work on improving quality, safety, and service Respect cultural and spiritual differences and honor individual preferences. Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.
Show courtesy and compassion with customers, team members and the community For more details: jobs-search. org/information-technology_oxford-c424328/licensed-practical-nursemedical-home-coordinator-oxford_i1950049315
