LPN/Health Coach (Medical Group) - FT - WellSpan Family Medicine - Trout Run - Days

Ephrata, PA | Physician Practices | Tracking Code: 48103

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General Summary:
Under the general supervision of the Case Management Nurse Supervisor and/or the Practice Leadership Team, provides safe, therapeutic and efficient care and services to patients. Supports the care team by functioning as a health coach for disease prevention and early screening, testing and treatment. Helps patients manage their chronic diseases. Assists in the care of patients, and instructs patients and their families in appropriate care, as directed by their provider. Functions as a member of the Care Coordination Team (CCT) to assist in the planning and implementation of patient care based upon sound clinical preparation, knowledge, skills and experience. Care is provided in accordance with the provisions of clinical certification or licensure with the Pennsylvania State Board of Nursing.

Duties and Responsibilities:
1 Provides support to patients of the practice for clinical outcome management; healthy lifestyle information, after appointment coordination and navigation of the health system.
2 Generates lists of patients to proactively remind patients, families and/or clinicians of service needs for prevention or chronic conditions.
3 Completes follow up calls to patients discharged from Hospital/ED. Arranges seven day follow-up and identifies issues/concerns to appropriate staff.
4 Utilizes the tracking/identification tool to monitor task completion, patient follow through and completion of health risk assessment.
5 Communicates with providers and CCT members on issues/concerns such as transitions in care between hospital, skilled nursing facility, rehab and home care.
6 Participates in daily huddles with other practice CCT members for review of at risk patients, follow up on issues and review of patients in hospital or practice in need of CCT services.
7 For patient populations where Wellspan is at financial risk, provides direct care management interventions such as: assisting patients with goal setting and action plans to manage their health and addressing barriers to patient adherence of treatment plan and goals; assisting patients with referral and participation in Wellness and Self Management programs; assisting patients with instruction and teach back of new medications as directed by the provider; monitoring patient outcomes/referrals/test results and addressing with CCT members; following up on interventions identified in care plan within scope of practice; and notifying payer/benefit manager when Case Management closes interventions, receives notifications from payer/community service or care coordination teams, and facilitates/communicates to CCT/providers.
8 Maintains patient records to ensure an accurate record of the patients medical treatment.
9 Provides health care information materials and reviews with patient and family members as directed by providers (i.e. VIS sheets etc.).
10 Under the direction of the provider, tracks, reviews and monitors follow-up of diagnostic test results. Relays information to patient from the provider regarding results and follow-up instructions.
11 Obtains comprehensive health information from patient/family members to review with providers or clinical resource at the time of the visit or over the phone. Uses this information to assist providers in determining the urgency for care or an alternative venue for care for patients with acute problems, should access not be readily available at the practice. This may include review of systems and history of present illness and/or past medical and social history. Documents in the patient record under the direction and supervision of the care provider. 
12 Provides standard patient care instruction and education as provided and directed by the care team. Completes education on health literacy and foundations of patient education.
13 Supports the care team by functioning as a health coach for disease prevention, early screening and testing and treatment and for helping patients manage chronic diseases.

Department Description:

The WellSpan Medical Group is a large multi-specialty group that employs more than 850 physicians and advanced practice clinicians in over 160 locations across south central Pennsylvania and northern Maryland. Working together and connected through a sophisticated electronic health record, these experts offer care and treatment for conditions that range from simple to complex – from the common cold to orthopedic injuries, neurologic problems and cardiovascular disease. The WellSpan Medical Group is proud of their low physician turnover, collaborative culture and strong commitment to physician leadership within their group.


Required Skills

Basic Cardiac Life Support

Licensed Practical Nurse

1-2 years experience required

Quality of Life

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multispecialty medical group of more than 1,200 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, six respected hospitals, more than 15,000 employees, and 140 patient care locations. WellSpan is a charitable, mission-driven organization, committed to exceptional care for all, lifelong wellness and healthy communities. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

Quality of Life
Quality of Life

Lancaster City was the capital of Pennsylvania from 1799 to 1812. Today, Lancaster County includes a vibrant downtown business district, desirable suburban neighborhoods and sprawling agricultural farms. Life in Lancaster County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, an independent professional baseball team, fine dining and more. When visiting Lancaster, one can't help but recognizing the influence of the Pennsylvania Dutch — farm-to-table and beyond.

Conveniently located in southcentral Pennsylvania, Lancaster is within an easy commute to major cities and has ready access to public transportation. Residents can find local employment in healthcare, tourism, public administration, manufacturing, and both professional and semi-professional services. (Patient population: 535,000)

Equal Opportunity Employment

WellSpan Health is an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

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