Licensed Vocational Nurse- Chronic Care Management

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    "requisitionDescription": "<p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;' data-pasted=\"true\"><span style='font-size: 18px; font-family: \"Segoe UI\", sans-serif; color: rgb(0, 0, 0);'>The intent of this job description is to provide a summary of the major duties and responsibilities performed in this job. Incumbents may be requested to perform job-related tasks other than those specifically presented in this description.</span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><br></span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;'><span style='font-size: 18px; font-family: \"Segoe UI\", sans-serif; color: rgb(0, 0, 0);'>The Licensed Vocational Nurse supports the Chronic Care Management program by providing ongoing care coordination, patient outreach, education, and clinical support for patients with chronic conditions. This role works collaboratively with providers, Registered Nurses, Medical Assistants, and the Care Management team to improve patient outcomes, support preventive care initiatives, reduce avoidable hospital utilization, and ensure high-quality patient-centered care.</span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><br></span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;'><span style='font-size: 18px; font-family: \"Segoe UI\", sans-serif; color: rgb(0, 0, 0);'>The LVN plays a key role in assisting patients with care plan adherence, transitions of care, medication reconciliation support, appointment coordination, and chronic disease education while maintaining accurate documentation within the electronic medical record.</span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><br></span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;line-height:90%;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><br></span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;line-height:90%;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><strong><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Essential Job Duties:</span></strong></span><span style='font-size: 18px; line-height: 90%; font-family: \"Segoe UI\", sans-serif;'><span style=\"color: rgb(0, 0, 0);\">&nbsp;Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</span></span><span style=\"font-size: 18px; color: rgb(0, 0, 0);\">&nbsp;</span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;line-height:90%;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\">&nbsp;</span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;line-height:90%;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><strong><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Patient Care Coordination</span></strong></span></p><div style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;'><ul style=\"margin-bottom:0in;list-style-type: disc;margin-left: -0.25in;\"><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Conduct outbound and inbound patient outreach for CCM services.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Assist with enrollment and onboarding of eligible CCM patients.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Maintain regular monthly patient contact per CCM program requirements.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Support development and reinforcement of individualized patient care plans.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Identify patient barriers to care and escalate concerns appropriately.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Coordinate follow-up appointments, referrals, and community resources as needed.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Assist with Transitional Care Management (TCM) and post-discharge follow-up workflows when assigned.</span></li></ul></div><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;margin-left:.25in;text-align:justify;line-height:90%;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><br></span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;line-height:90%;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><strong><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Clinical Support</span></strong></span></p><div style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;'><ul style=\"margin-bottom:0in;list-style-type: disc;margin-left: -0.25in;\"><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Review and update patient histories, medications, and chronic condition information.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Perform medication reconciliation under provider/RN direction and within LVN scope of practice.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Monitor patient-reported symptoms, vital health concerns, and changes in condition.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Escalate urgent or clinically significant findings to RN or provider promptly.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Reinforce care plans and chronic disease education with patients and caregivers.</span></li></ul></div><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;margin-left:.25in;text-align:justify;line-height:90%;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><br></span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;line-height:90%;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><strong><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Documentation &amp; Compliance</span></strong></span></p><div style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;'><ul style=\"margin-bottom:0in;list-style-type: disc;margin-left: -0.25in;\"><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Accurately document all patient interactions and CCM activities in Athena EMR and/or designated tracking systems.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Ensure documentation supports CCM billing and compliance requirements.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Maintain confidentiality and comply with HIPAA regulations.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Participate in quality improvement initiatives and workflow optimization efforts.</span></li></ul></div><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;margin-left:.25in;text-align:justify;line-height:90%;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><br></span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;line-height:90%;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><strong><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Collaboration &amp; Communication</span></strong></span></p><div style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;'><ul style=\"margin-bottom:0in;list-style-type: disc;margin-left: -0.25in;\"><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Collaborate with providers, hospital teams, specialists, home health agencies, SNFs, and community partners to support continuity of care.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Participate in team huddles, case reviews, and interdisciplinary meetings.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Communicate professionally and compassionately with patients, families, providers, and staff.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; color: rgb(0, 0, 0);\"><span style='line-height: 90%; font-family: \"Segoe UI\", sans-serif;'>Assist with patient education and engagement initiatives to improve adherence and outcomes.</span></li></ul></div><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;line-height:90%;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><strong>&nbsp;</strong></span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><strong><span style='font-family: \"Segoe UI\", sans-serif;'>Required education and experience: </span></strong></span><span style='font-size: 18px; font-family: \"Segoe UI\", sans-serif; color: rgb(0, 0, 0);'>The requirements listed below are representative of the knowledge, skills, and/or ability required.&nbsp;</span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><strong>&nbsp;</strong></span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><strong><span style='font-family: \"Segoe UI\", sans-serif;'>Minimum Education required:&nbsp;</span></strong></span></p><ul style=\"margin-bottom:0in;margin-top:0in;\" type=\"disc\"><li style=\"margin: 0in; font-size: 18px; font-family: initial; text-align: justify; color: rgb(0, 0, 0);\"><span style='font-family: \"Segoe UI\", sans-serif;'>Current California Licensed Vocational Nurse (LVN) license in good standing.</span></li></ul><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><strong><em>&nbsp;</em></strong></span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><strong><span style='font-family: \"Segoe UI\", sans-serif;'>Minimum Experience Required:&nbsp;</span></strong></span></p><ul style=\"margin-bottom:0in;margin-top:0in;\" type=\"disc\"><li style=\"margin: 0in; font-size: 18px; font-family: initial; text-align: justify; color: rgb(0, 0, 0);\"><span style='font-family: \"Segoe UI\", sans-serif;'>Minimum one (1) year of clinical experience in ambulatory care, case management, primary care, population health, or chronic disease management preferred.</span></li></ul><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><br></span></p><p style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;'><span style=\"font-size: 18px; color: rgb(0, 0, 0);\"><strong><span style='font-family: \"Segoe UI\", sans-serif;'>Minimum Knowledge and Skills Required:</span></strong></span></p><ul style=\"margin-bottom:0in;margin-top:0in;\" type=\"disc\"><li style=\"margin: 0in; font-size: 18px; font-family: initial; text-align: justify; color: rgb(0, 0, 0);\"><span style='font-family: \"Segoe UI\", sans-serif;'>Knowledge of chronic disease processes and care coordination principles.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; text-align: justify; color: rgb(0, 0, 0);\"><span style='font-family: \"Segoe UI\", sans-serif;'>Strong communication, organizational, and time management skills.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; text-align: justify; color: rgb(0, 0, 0);\"><span style='font-family: \"Segoe UI\", sans-serif;'>Ability to work independently while functioning effectively within a team environment.</span></li><li style=\"margin: 0in; font-size: 18px; font-family: initial; text-align: justify; color: rgb(0, 0, 0);\"><span style='font-family: \"Segoe UI\", sans-serif;'>Proficiency with EMR systems and Microsoft Office applications. 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