LVN Health Care Coordinator Well Med at SW Military
: Job Details :

$2,200. Sign on Bonus Available for External Candidates

Incentive Bonus 2 times a year

18 days of PTO & Closed on Major Holidays

401K Match

WellMed, part of the Optum family of businesses, is seeking a Licensed Vocational/Practical Nurse to join our team in San Antonio, TX. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

The Healthcare Coordinator is responsible for successfully supporting patients with high risk health conditions to navigate the healthcare system. The Healthcare Coordinator assists in developing patient empowerment by acting as an educator, resource, and advocate for patients and their families to ensure a maximum quality of life. The Healthcare Coordinator interacts and collaborates with multidisciplinary care teams, to include physicians, nurses, pharmacists, laboratory technologists, social workers, and other educators to support the transition of care process. The Healthcare Coordinator acts as a resource for clinic staff. The Healthcare Coordinator works in a less structured, self-directed environment and performs all nursing duties within the scope of a LVN/LPN license of the applicable state board of nursing.

Primary Responsibilities:

• Works with the providers and clinic staff to identify patients at high risk through transitions of care. This is to support the market initiative of reducing utilizations, including ER visits, hospital admissions, and hospital readmissions
• Supports longitudinal care of the patient with chronic care conditions by:
  • Performing assessment of health conditions
  • Initiating medication reconciliation for PCP to complete
  • Conducting Motivational Interviewing and Self-Management Goal setting
  • Providing patient education
• Supports transition of the patient with chronic care conditions from inpatient to outpatient setting, by:
  • Performing assessment of transitional needs
  • Initiating medication reconciliation for PCP to complete
  • Establishing and reviewing contingency plan and 24/7 patient support availability
  • Providing patient education in a self-management format
  • Completing 3 in 30 on all high risk members experiencing a discharge
  • Ensure a 7 calendar day follow up with PCP post discharge
  • Assisting with post discharge needs such as prescriptions, transportation, Durable Medical Equipment (DME), appointments by creating and following up on social work referrals
  • Refers to case management for complex case needs, longitudinal needs, and/or disease management
• Coordinate with providers to establish or update plan of care
• Performs accurate and timely documentation in the electronic medical record
• Participates in daily huddles and Patient Care Coordination (PCC) meetings
• Prepares accurate and timely reports, as required, for weekly meetings
• Maintains continued competence in nursing practice and knowledge of current evidence based practices
• May perform clinical tasks within their scope of practice
• Performs all other related duties as assigned

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors' offices. At WellMed our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Licensed Practical/Vocational Nurse with an active and unrestricted license to practice in the state of employment
• Current BLS certification
• 2+ years of experience in a physician's office, clinical or hospital setting
• Knowledge of chronic diseases, especially COPD/asthma, diabetes, CHF and IHD
• Excellent verbal and written skills
• Solid interpersonal skills
• Ability to interact productively with individuals and with multidisciplinary teams
• Proficient computer skills to work efficiently with electronic medical records
• Excellent organizational and prioritization skills

Preferred Qualifications:

• IV Certification
• Experience related to patient education and/or motivational interviewing skills and self-management goal setting
• Experience with outbound patient telecommunications
• Fluent written and verbal skills in English and Spanish

Physical & Mental Requirements:

• Ability to lift up to 35 pounds
• Ability to push or pull heavy objects using up to 35 pounds of force
• Ability to sit for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.