Enhanced Care Management In-Person LVN

Job Summary
You will play a crucial role as the face-to-face point of contact for our patients. Your primary responsibility will be to conduct in-home outreach to onboard complex care patients identified by the health plan. You will explain the program to the family, provide health needs assessments, and develop a care plan with the supervising physician. You will set SMART goals with the family and work with community health workers to implement the care plan over a one-year period to improve patient outcomes.
Sowing Seeds Health is a fast-growing care management non-profit community-based organization in California. We are looking to provide enhanced care management in the following counties: Tulare, Calaveras, Mono, Inyo and Amador Counties.
Key Responsibilities:
• Conduct initial and monthly in-home assessments and implement care plans over a 1 year period for each patient.
• Ability to complete notes onsite instead of post visit, documenting visit summary, goals and care plan discussed with the family each visit.
• Communicate patient updates effectively after each ED/hospitalization for CHW to coordinate care and update care plan with supervisor.
• Make 6-8 home visits a day.
Qualifications:
• Must be a Licensed Vocational Nurse (LVN) in good standing with the state board of nursing.
• Must have experience driving to patient homes and make 6-8 visits a day. ·
• Minimum of 1 year of nursing experience; experience in home of pediatric case management is a strong plus.
• Proficiency in patient assessment and clinical documentation.
• Strong interpersonal and communication skills for interacting with patients, families, and teams.
• Ability to work independently and manage time effectively during home visits.
• Compassionate, patient-centered approach to care.
• Other: Reliable transportation, valid CA driver's license, and current LVN license.
How to Apply: Ready to make a direct impact on patient care from the ground up? Please submit your resume and a brief cover letter to hope@sowingseedschc.org.
Benefits:
• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance
Work Location: In person