Job Description
The Licensed Practical Nurse - Transitional Care Coordination will focus on care coordination in full for the PACE participants. This will include following up on patients post hospital discharge, post ER visits, post procedures, post-surgery and follow up on any acute changes or symptoms which may arise via patient phone calls.

They work to avoid readmission to hospitals and skilled nursing facilities by helping to manage all aspects of the care from inpatient stay to home. This role will: identify high-risk, complex patients and communicate with all entities involved in the care of the patient to promote and maximize care coordination; uses all components of the transitional care model and nursing process including assessment, triage, planning, implementing, and evaluating care to meet the patients' needs; and plans, organizes, and provides nursing services to clinic patients in conjunction with clinic Providers and Registered Nurses.

Position Requirements

• Education - Completion of a Licensed Practical Nurse program and current Washington State LPN license.
  
• Experience - A minimum of one year of LPN experience is required, along with proficiency in utilizing electronic health records. Experience with the geriatric population is preferred.
  
• Other Requirement(s) - Fluency in English and prefer fluency in API language.