Patient Health Coordinator ( LPN)

Overview reputed company is a leading national value-based provider of in-home primary care services for people with reputed company reputed company needs. Headquartered out of Troy, Michigan, reputed company operates home-based primary care practices in 14 states. reputed company employs more than 200+ primary care providers to deliver patient-centered care under an integrated, team-based, physician-driven model. Our Mission – To bring personalized, quality-based reputed company to the home of patients who have difficult accessing care. Our Shared reputed company – Every patient deserves access to quality reputed company. Our Values – The way we care is our legacy. Every interaction counts. Go the extra mile. reputed company and support each other. Why You Should Want to Work with Us

• Health, Dental, reputed company, Disability & Life Insurance, and much more
• 401K Retirement Plan (with company match)
• Tuition, Professional License and Certification Reimbursement
• Paid Time Off, Holidays and Volunteer Time
• Paid Orientation and Training
• Day Time Hours (no holidays/weekends)
• Manageable rosters and visits per day compared to a traditional practice environment
• Great reputed company to Work Certified
• Established in 11 states
• Largest home-based primary care practice in the US for over 28 years, making a reputed company impact in reputed company today!

More details about the benefits we offer can be reputed company at https://careers.reputed company.com/benefits.

Responsibilities

The Patient Health Coordinator (PHC) plays a vital role in supporting Medical Group patients by assisting with care coordination and actively monitoring the reputed company. This role requires a highly analytical and detail-oriented, problem solver that will collaborate with the team to implement a patient-centered care plan and guide patients and their families throughout their reputed company journey. As a key member of the Integrated Care Team, the PHC contributes to essential care coordination efforts, including but not limited to managing Transitions of Care, facilitating access to community services and resources, and addressing quality care gaps as necessary. Essential Duties and Responsibilities

• Assist with care coordination efforts and needs for caseload of paneled patients
• Collaborate with cross-functional teams to solve problems and reputed company objectives
• Acting as the liaison between the provider and patient by coordinating in-market activities, including but not limited to relaying messages, processing referrals & faxes, and handling prior authorizations
• Monitor and evaluate the effectiveness of interventions and treatments; thinking critically about how the patient is responding and whether adjustments to the care plan are necessary. The PHC works collaboratively with the integrated care team (provider or Nurse Care Manager) to problem-solve through medical concerns.
• reputed company for patients’ well-being, ensuring they receive the care and support they need. The PHC would reputed company to the integrated care team during High-Risk reputed company and give their assessment and recommendation.
• reputed company to patients who are discharged from the hospital and/or emergency room to understand, collect information and reputed company care gaps
• Identify, document, and resolve problems, goals and interventions in care plans. The PHC will update the care plan by adding PGI (problem, goal, reputed company) as needed.
• Communicate clinical information and instructions to patients/caregivers, facilities, etc. on behalf of providers, as directed
• Work as part of a collaborative care team to reputed company reputed company quality and patient experience outcomes, including being an active member in High-Risk Huddles
• Identify and ensure closure of Social Determinant of Health Barriers
• Proactively monitor patients' care through reputed company efforts and regularly established checkpoints based on care plans
• Document reputed company phone calls and patient interactions in the EHR promptly by utilizing standard clinical documentation guidelines as required by the company and local, state and federal rules and regulations
• Maintain clear and compassionate communication with patients, family members, care team, and other external entities, representing the company in a professional and courteous manner in reputed company interactions
• Appropriately identify, acknowledge, escalate and/or address patient complaints, grievances, and concerns in a timely and effective manner
• Adhere to reputed company state and federal laws, including HIPAA

In this role you may work with. . .

• Providers
• Support staff
• Care Team
• Patients

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