Clinic Healthcare Coordinator LVN WellMed at Park Springs, Arlington TX

Primary Responsibilities

• Works with the PCP and clinic staff to identify patients with high risk diagnoses such as CHF, IHD, COPD/asthma and diabetes and ensures clinical guidelines are being followed
• Contacts and performs initial interviews with patients who are in need of health coaching programs
• Conducts Chronic Care Model visits and reviews the patient's informal and formal support systems, focusing on what patients want to improve and educating them about their chronic disease
• Provide necessary coaching to reduce or eliminate behaviors that are considered high-risk
• Identify the required goals that each patient must fulfill and advise feasible options for achieving goal
• Ensure that patients are made aware of health issues, concerns and the way in which one could combat them
• Must raise awareness about the different available exercises, weight loss programs and other dietary requirements necessary for a healthy lifestyle
• Utilizes appropriate motivational interviewing techniques necessary for coaching and assisting the patient to complete a self-management goal/action plan
• Must be able to provide a chart of habits and lifestyle changes that are imperative for the improvement of the concerned patient's health
• Enters timely and accurate data into the electronic medical record to communicate patient needs and to ensure complete documentation of patient visits and phone calls. Tracks self-management goal outcomes and documents in electronic medical record
• Maintains current knowledge regarding CHF, IHD, COPD/asthma and diabetes as well as related treatments and complex medications
• Affords assistance, initiates referrals, and coordinates transitions of care regarding hospitalization follow-up, palliative care, hospice, etc.
• Establishes a trusting relationship with identified patients, caregivers, clinic staff members and physicians
• Attends educational offerings to keep abreast of change and complies with licensing requirements, ensures all patient educational materials are up-to-date, and maintains knowledge of specialty and ancillary provider contract contents, to include exclusions and contract terms
• Conducts clinic one-on-one visits with Disease Management Chronic Care Program participants, utilizing the Chronic Care Model, to assess patient needs for DME, home health, value-added services and any other necessary resources. Communicates these needs to the appropriate person (i.e. Social Worker, clinic staff, etc.) or addresses them per process
• Collaborates with the nurse manager to recommend policies, procedures and standards which affect the care of the patient with high-risk chronic disease diagnoses such as CHF, IHD, COPD/asthma and diabetes
• Performs all other related duties as assigned. i.e. IV Insertion with hydration fluid administration, wound care, dressing changes, suture removal, insertion and removal of urinary catheters, and etc.

Required Qualifications

• High school diploma or GED
• Licensed Vocational Nurse with a current license to practice in the state of employment
• 2+ years of experience in a physician's office, clinical or hospital setting
• Cardiac, medical-surgical and/or critical care experience
• Experience related to patient education and/or motivational interviewing skills and self-management goal setting
• Proficient knowledge of chronic diseases, especially COPD/asthma, diabetes, CHF and IHD
• Proficient computer skills, including Microsoft Word, Excel, Access and Outlook
• This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease

Preferred Qualifications

• 5+ years of experience in a physician's office, clinical or hospital setting
• Knowledge of managed care, referral processes, claims and ICD-9 and CPT coding
• Excellent verbal and written skills
• Ability to interact productively with individuals and with multidisciplinary teams
• Excellent organizational and prioritization skills