Community Care Coordinator (LPN), UCM Care Network Job at The University of Chicago Medicine
Job Description:
Primary Job Functions:
Qualifications:
The South Side Healthy Community Organization, Inc. (SSHCO) is a coalition created to improve access to care across Chicago’s South Side. There are 13 Chicago hospitals, health systems and federally qualified health centers participating in the coalition. SSHCO is a collaboration model, which is dedicated to expanding primary, specialty and preventative care to increase support in our community. The development of a technology platform plans to connect South Side providers to better coordinate and provide care for our patients across the continuum.
As an integral member of SSHCO, the
Community Care Coordinator (LPN) will be assigned to work at a designated SSHCO’s federally qualified health center site. This site is part of a collaborative to ensure patient needs for the South Side’s underserved patient population are met and care delivery is coordinated across the continuum. The Community Care Coordinator provides experience and expertise to the SSHCO model of care while acting as a patient advocate.
Primary Job Functions:
- In this role, you will utilize critical thinking skills to perform timely coordination to meet individual’s unique healthcare needs to promote positive outcomes. You will seek the expertise of primary care physicians, medical directors, specialists, social workers, and other disciplines involved in the collaboration model.
- The Community Care Coordinator assists staff, patients, and family members to work with Chicagoland community and state agencies to coordinate care for patients with chronic diseases. Positive and professional efforts will be targeted to promote patient/provider satisfaction and to resolve or escalate any patient care issues to the Nurse Care Coordination Supervisor, when appropriate.
- Patient care plans are developed based on mutual goals for the patient, family, and the provider’s emergency plan, medical summary, and ongoing action plan as appropriate. Close monitoring of patient adherence and goal progress takes place within the plan of care, and changes are facilitated or escalated as needed.
- The incumbent performs duties and tasks in accordance with performance standards established for the job. They are also responsible for participation in, and completion of, all patient safety initiatives appropriate to the position and the designated staff at their site. The Care Coordinator conducts all job responsibilities in coalescence with the mission and values of SSHCO.
- Maintains the ability to work with a designated patient caseload and deal with rapidly changing priorities.
- Identifies, plans, and facilitates strategies to provide appropriate clinical health coaching to support patients with self-management of their chronic disease and lifestyle changes to mitigate health risk.
- Ensures that all critical elements of the care plan and transition of care plan have been communicated to physician, multi-disciplinary team, patient and family including expediting teaching needs.
- Completes tasks related to transition of care documents, quality care gaps, and various other quality and performance measure processes. Ensures adherence to Quality Standards and Participation in Quality Monitoring and Improvement.
Qualifications:
- 5 or more years’ experience working in a clinical setting as a Licensed Practical Nurse.
- Experience working in case management, care coordination, or home health.
Licensure/Certifications:
- Active Licensed Practical Nurse through the state of Illinois.
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