Licensed Practice Nurse - Chronic Care Management

St. Louis, MO
~ Partner Practices ~ – ~ Partner Practices /
Partner Practice /
On-site
Location: St Louis Medical Clinic
Job Title: Licensed Practical Nurse (LPN) - Chronic Care Management Full Time

Job Description:
The LPN in Chronic Care Management is a healthcare professional responsible for providing and coordinating care for patients with chronic conditions. This role is crucial in improving the health outcomes of our patient population.

Responsibilities:
1. Provide 20 minutes or more of chronic care management services per patient per 30-day period.
2. Ensure access to CCM services, giving patients a way to make timely contact with healthcare providers to address urgent chronic care needs.
3. Ensure continuity of care with a designated practitioner or member of the care team, and facilitate successive appointments with them.
4. Manage care transitions between and among healthcare providers and settings.
5. Coordinate with home and community-based clinical service providers as appropriate.
6. Offer enhanced opportunities for the patient and any relevant caregiver to communicate with the care team.
7. Conduct systematic assessments of the patient’s medical, functional, and psychosocial needs.
8. Implement system-based approaches to ensure timely receipt of all recommended preventive care services.
9. Oversee medication reconciliation with a review of adherence and potential interactions, and manage patient self-management of medications.
10. Create a patient-centered care plan document to assure care is provided in a way that is compatible with patient choices and values, and provide a written or electronic copy of the care plan to the patient.

Qualifications:
1. Valid LPN license.
2. Experience in chronic care management is preferred.
3. Strong communication and interpersonal skills.
4. Ability to work in a team and coordinate with various healthcare providers.
Please note this position is posted on behalf of our partner practices. This individual will be working at the specific practice that is mentioned in the above details and will not be a direct employee of Aledade, Inc. so will therefore not be eligible for the benefits available to Aledade employees.