Transition of Care LPN

4 days ago

Seattle, Washington, United States SeaMar Community Health Centers Full time
Job Title: Transition of Care LPN

Sea Mar Community Health Centers is seeking a skilled and compassionate Transition of Care LPN to join our team. As a Transition of Care LPN, you will play a vital role in ensuring the smooth transition of patients from one level of care to another, promoting health care continuity, and preventing preventable poor outcomes among at-risk populations.

Job Summary:

The Transition of Care LPN will work closely with the care management and transition of care teams to deliver specific time-limited services to identified patients. This includes advocating and educating patients and/or caregivers during transitional periods between hospitals and/or other facilities and the patient's home.

Key Responsibilities:
  • Provide medication self-management support to patients, ensuring they are knowledgeable about their medications and have a medication management system in place.
  • Collaborate with staff in hospitals and care facilities, as well as Sea Mar providers, to resolve gaps in care and improve clinical outcomes related to plan all-cause readmission, utilization of hospital services, patient engagement after inpatient discharge, and medication reconciliation post-discharge.
  • Support patients in scheduling and completing follow-up visits with their primary care physician and/or specialist, promoting active participation in their care.
  • Identify and address red flags indicating a patient's condition is worsening, ensuring timely interventions.
Requirements:
  • LPN with social service experience, preferably in home health, hospice, long-term care, case management, care coordination, wellness coaching, or a related field.
  • CCM or CCTM certification is preferred.
  • Experience working with underserved, transient populations, substance use disorders, chronic mental illness, and chronic health conditions.
  • Strong knowledge of community resources and experience working with community agencies.
  • Typing proficiency of at least 45 wpm and active LPN license with the WA State Department of Health.
  • Bilingual (Spanish/English) is preferred.
What We Offer:

Sea Mar Community Health Centers offers a dynamic and growing work environment, with opportunities for advancement and professional growth. Our comprehensive benefit package includes medical, dental, vision, prescription coverage, life insurance, long-term disability, EAP, paid-time-off, and 401(k)/retirement options.

We are an equal opportunity employer and welcome applications from diverse candidates. If you are passionate about delivering high-quality care and making a difference in the lives of our patients, please submit your application.

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