(Archived) LPN Community Care

Become part of a team focused on the care of the frail, poly-chronic, elderly Medicare Advantage patients. This population is typically underserved and very challenged with access to care. To address these problems, we have elected to bring the care to the patient, instead of trying to bring the patient to the care. Care is provided throughout the entire continuum of care – from chronic care and urgent care in the home, to hospital, to skilled nursing facility, to assisted living, to palliative care, to end of life care. WellBe's physician/advanced practicing clinician led geriatric care teams’ partner with the patient’s primary care physician to provide concierge level geriatric medical care and social support in the home as well as delivering and coordinating across the entire care continuum.

GENERAL SUMMARY

The LPN Visit Facilitator will play a vital role in delivering white glove, high-quality services to patients who need your help in the comfort of their own home. This position requires a combination of conducting in-person patient visits, supporting administrative tasks, and facilitating telehealth patient consults with Nurse Practitioners or Physicians as required. The LPN Visit Facilitator role will be the local market expert and will act as a connector for patient support services. This role will be responsible for working closely with our Telehealth provider team and social worker team to provide deliver the highest quality of care to our patients. The role has no direct reporting responsibility but will function as part of an integrated, interdisciplinary patient care team. Daily, local travel to meet patients and the community will be an essential part of your role.

Responsibilities:

SKILLS & COMPETENCIES

• Facilitate in-home Telehealth visits between Nurse Practitioner and Patient, including initial patient assessments and on-going follow-up visits as appropriate per patient need.
• Complete and document thorough home safety inspection during patient visits.
• Check and record health vitals including weight, blood pressure, heart rate, lung sounds, and blood sugar levels, as well as potential health challenges noted during the home visit and/or reported by each patient.
• Provides support for patient care needs at the direction of the assigned Provider.
• Responsible for patient education needs at the direction of the assigned Provider.
• Reviews patient care interventions and assessment of patient needs for transitions of care, end of life discussions, addressing HEDIS gaps (med adherence) and palliative care interventions.
• Completes and submits all documentation/paperwork requirements daily.
• Attends Interdisciplinary Team (IDT) meetings and provides additional information on any patient/family interactions.
• Collaboration with other care team members on patient care strategies.
• Attend all required trainings, including equipment/device training. Ongoing training to be expected and additional education, skills, and protocols will be added

Qualifications:

Educational/License Requirements:

• Active Oregon State Licensure and reside in the state of Oregon.
• 3+ years as an LPN in a direct, patient-facing care delivery role
• Prior Telehealth experience preferred.
• Previous experience in home care, hospice, palliative care, or geriatrics strongly preferred, other complex patient health care experience also beneficial.
• Possess a valid driver’s license with an acceptable driving record.
• Requires proof of active auto insurance policy.
• CPR Certification required.

Required Skills and Abilities:

• Strong communication skills, with the ability to effectively interact with patients, families, and remote healthcare professionals.
• Ability to work independently and make sound decisions while adhering to established protocols and guidelines.
• Excellent organizational and time management skills to handle administrative tasks and facilitate telehealth consultations.
• Understanding of Risk Assessment and Quality measures
• Familiarity with electronic medical records (EMR) systems and basic computer skills
• Understanding of full-risk or value-based care
• $50,000 - $ 69,000 plus benefits