Bilingual LPN Care Coach

Summary

Join CircleLink Health® as a remote Care Coach, working 20-25 hours per week with a team of nurses to manage patients with chronic conditions in Medicare's Chronic Care Management program. You will educate patients on self-management, implement and improve their plan of care, utilize motivational interviewing techniques, conduct transitional care management, reduce care gaps, and connect patients with community resources. This 1099 contract position requires a current, unrestricted Compact LPN license, 5+ years of experience as an LPN, proficiency with electronic health records, and fluency in English and Spanish. Compensation is based on clinical encounters and additional incentives are available for patient withdrawals and unsuccessful contact attempts.

Requirements

• Fluent in English AND Spanish
• Meet communication skills, must be self-directed, able to work independently with little supervision while meeting performance metrics
• Passion for nursing
• Detail-oriented
• Excellent organizational and time management skills
• Strong communication and telephonic skills
• Strong critical thinking and problem-solving skills
• Commitment to certain number of hours per day and days of week
• Availability to make calls on weekdays between 9am-6pm ET
• This role cannot be held alongside a full-time position
• LPN needs a STRONG internet-connected computer
• Current, unrestricted Compact LPN license
• Proficiency with electronic health records and web based applications
• 5+ years experience as a Licensed Practical Nurse

Responsibilities

• Educate patients on self-management skills and goal setting
• Implement and improve the Plan of Care by updating medications, appointments due, record biometrics, vital signs, and care coaching provided
• Utilize Motivational Interviewing or other behavior change techniques to coach and assist the patient with self-management
• Conduct Transitional Care Management activities to high risk patients discharged from the hospital and the ER to reduce unnecessary readmissions, including medication reconciliation, medication adherence, identify red flags, address barriers, encourage follow-up care, how and when to seek appropriate level of care
• Reduce care gaps by encouraging or assisting with preventive care, and chronic care management, i.e. annual well visits, follow up visits, medication management, pre-visit labs, diagnostic tests due, preventive cancer screens
• Connect the patient with community resources as needed, including transportation, personal care needs, homemaker or chore services, social services, etc

Preferred Qualifications

• Case Management or Chronic Disease Management experience
• Case Management Certification
• Certified Diabetes Educator
• Transitional Care Management experience
• Experience with Motivational Interviewing or other behavior change communication techniques

Benefits

• Compensation is paid at the rate of $10.00 per initial clinical encounter per patient per month
• A clinical encounter occurs after two criteria are met: a patient has a successful clinical call, and the patient has 20 minutes or more of time in their chart timer
• In addition to successful clinical encounters, Care Coaches shall be entitled to $3.00 in the event that a patient within their caseload withdraws from the Chronic Care Management Program
• Additionally, a compensation of $4.00 will be paid out following five unsuccessful attempts to contact the patient without receiving a response