LVN Care Coordinator | Low Desert

Who we are:

We are a healthcare company that puts heart and compassion above all else. Millions of Americans just aren’t getting the medical care they need. We’re on a mission to change that. For patients that means exceptional support and better care. For providers it means better support and time to focus on patients, and for partners that means higher quality and lower cost.

Join us in our mission!

Job Summary: The Nurse Care Coordinator is an essential part of the ECM team. Enhanced Care management (ECM) is a funded through California Advancing and Innovating Medi- Cal (CalAIM), and are programs that coordinate care by utilizing a person-centered approach to maximizing individual’s health and life trajectory. ECM services are medically appropriate and cost-effective alternatives to services covered under the state plan. All potential ECM members must be enrolled in Inland Empire Health Plan (IEHP). Titanium will begin outreach and engagement to promote the services, enroll the members in the ECM program, and provide services intended to improve their social and physical determinants of health. Members remain in the ECM programs until they no longer need or want the services. ECM services consist of a care team providing in-person care management and care coordination that aims to ensure services are available from Managed Care providers for members who are frequent utilizers of health services and individuals experiencing homelessness. The program is designed to leverage existing community care management, sustaining, housing transition, navigation, infrastructure, and experience.

Essential Functions:

• Facilitates access to primary care and behavioral health providers, as needed.
• Responsible for working effectively with and as part of the Titanium’s interdisciplinary team to provide high quality, effective care management to ECM members.
• Engage members in skilled therapeutic interactions to promote health behaviors, other behavioral health interventions within scope.
• Coordination of care including resource linkages, working with other professionals and organizations in the community to ensure quality of care for members.
• Seamless transition of care that meets IEHP’s requirements for post ER visits and hospitalizations.
• Completing regularly scheduled follow-up visits.
• Provides care coordination through phone calls, emails, messages, updating calendars, scheduling appointments, data entry, attending meetings.
• Supports BH Care Manager, Community Health Worker, and Care Coordinator with delegated tasks.
• Collaborates on Member care issues with other ECM Care Team Members, participating in weekly systematic case reviews and ad hoc case reviews.
• Consults with Clinical Nurse Leader and/or the Behavioral Health Care Manager before taking any action that is clinical in nature.
• Uses strategies to engage Members in care as well as motivational interviewing.
• Provides health education to members within scope of practice.
• Initiates a care plan and completes all necessary assessments per healthcare plan guidelines.
• Understands and abides by all departmental and companywide policies and procedures.
• Performs other duties as assigned or required.

Qualifications:

• Education: High School Diploma/GED, Associates (Preferred)
• Experience: 2 years’ experience as an LVN working in a healthcare setting, such as a medical clinic or acute care hospital.
  • Experience with an EHR/EPM; eClinical Works (ECW) experience preferred.
  • Experience working in an internal medicine clinic preferred.
  • Care Management experience (preferred).
• Language: Fluent in English (written and verbal). Bilingual preferred.
• License/certification: Valid, unrestricted state LVN license.
  • Valid BLS certification from the American Heart Association Preferred
  • Valid CPR Certification Preferred
• Skills required:
  • Competent with computers, email, virtual platforms, Excel and other Microsoft Office based programs.
  • Excellent verbal and written communication skills, including the ability to convey and exchange information in a clear, effective manner.
  • Ability to identify problems and use logic and related information to develop and implement solutions.
  • Ability to work independently and carry out assignments to completion within the parameters of established policies and procedures.
  • A valid California driver’s license and clean driving record. A reliable vehicle and valid automobile insurance is mandatory, as automobile travel is required in the Inland Empire.

Physical Requirements: Physical demands associated with office work and driving, including but not limited to:

• Consistently operating office equipment such as a telephone and computer.
• Must be able to be in the field providing services to members 70% of the time.
• Must be able to perform 30% of duties remotely or in the office.
• Frequently moving or carrying office equipment weighing up to 15 pounds.
• Ability to travel to meetings and different office locations as required or requested.