Transition of Care LPN

4 weeks 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 Transition of Care LPN to join our team in Seattle, WA.

About the Role:

The Transition of Care LPN will work closely with the care management and transition of care teams to ensure seamless care transitions for patients. This role will involve delivering specific time-limited services to identified patients, designed to ensure health care continuity, avoid preventable poor outcomes among at-risk populations, and promote the safe and timely transfer of patients from one level of care to another and from one type of setting to another.

Key Responsibilities:
  • Provide advocacy and education for patients and/or caregivers during transitional periods between hospitals and/or other facilities and the patient's home.
  • Collaborate with staff in hospitals and care facilities and with Sea Mar providers to resolve gaps in care, 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 with a focus on medication self-management, patient-centered record, primary care and specialist follow-up, and knowledge of red flags.
Requirements:
  • LPN with social service experience, preferably in home health, hospice, long-term care, case management, care coordination, wellness coaching, etc.
  • CCM or CCTM certification preferred.
  • Experience working with underserved, transient populations.
  • Experience working with substance use disorders, chronic mental illness, and chronic health conditions.
  • Experience working with community agencies and strong knowledge of community resources.
  • Experience with motivational interviewing, the teach-back method, or patient counseling and education preferred.
  • Active LPN License with WA State Department of Health.
  • Typing proficiency of at least 45 wpm.
  • Bilingual (Spanish/English) preferred.
What We Offer:

Sea Mar offers talented and motivated people the opportunity to work in a dynamic and growing community health organization. We provide a comprehensive benefit package, including medical, dental, vision, prescription coverage, life insurance, long-term disability, EAP, paid-time-off, and 401(k)/Retirement options.

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