Imagine a career at one of the nation's most advanced health networks.Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.SummaryConducts assessments of patient/family needs for the highest risk patients or those patients at risk for poor outcomes. Collaborates with health professionals across the continuum; formulates a documented plan of care that ensures continuity and goal-setting that equips individuals and their families to easily access resources and adopt healthy lifestyles.Job DutiesOversees care management functions and related tasks for a designated population.Utilizes computer databases and documentation systems and develops and maintains accurate case records of all patients. Promotes patient self management, provides education about disease processes, and empowers patients and families to achieve maximum levels of wellness and independence.Evaluates medical, rehab, psychosocial socioeconomic, psychological, and physical needs and makes referrals.Provides medication management, including medication reconciliation during care transitions for the highest risk patients.Identifies issues related to the healthcare system, transportation, financial, and/or psychological barriers and works collaboratively to problem solve, coordinate services, and to advocate for patients/families.Provides care management for the highest risk patients to reduce risk and emergency department utilization to improve outcomes.Identifies patient and/or clinic staff knowledge to understand deficits regarding specific programs.Collaborates with all levels of the clinical team to improve processes, communication, and team skills needed to provide the best care to patients.Provides coordination of care for the highest risk patients experiencing a transition to or from care facilities and/or providers.Minimum QualificationsBachelor’s Degree in Nursing. Experience in lieu of Bachelor's degree may be considered. 5 years Experience in at least one of the following settings: case management, disease management, home health care, hospital, or physician office setting and2 years Prior electronic medical record (EMR) experience Ability to incorporate strategies for interacting with persons from diverse backgrounds. Effective behavioral and educational strategies such as motivational interviewing, teach-back method, and self-management support. Ability to set priorities to coordinate care plan efficiently. Ability to recognize the role of cultural, social, economic, and behavioral factors in accessibility, availability, acceptability, and delivery of public health services. CACRN - Certified Ambulatory Care RN - State of Pennsylvania orCCCTM - Cert Care Coord-Transition Mgt MSNCB - State of Pennsylvania orRN - Licensed Registered Nurse_PA - State of Pennsylvania Preferred QualificationsMaster’s Degree Nursing Physical DemandsLift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.https://youtu.be/GD67a9hIXUYLehigh Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases, our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes.
