• Serve as a primary point of contact for patients navigating chronic care programs • Deliver scheduled and unscheduled telephonic or virtual outreach in Spanish and English • Educate patients on medication use, symptom monitoring, nutrition, and lifestyle changes • Review RPM alerts and trends, escalating clinical concerns appropriately • Support post-discharge follow-up and specialty care coordination • Partner with pharmacists, nurses, and care teams to optimize outcomes • Ensure all documentation meets CMS, payer, and internal quality standards • Promote patient trust, activation, and adherence to care plans

• Establish rapport and trust with constituents to initiate a supportive, person-centered relationship • Assess individual needs and guide constituents to the most appropriate staff member, service, or resource • Provide accurate information about Multiple Sclerosis as well as Society programs, events, and services • Connect constituents with MS Navigators for ongoing support and goal achievement • Collaborate with healthcare providers to create seamless experiences for shared clients • Ensure equitable access to educational and support resources, regardless of technical ability • Respond to acute situations with sound judgment, connecting individuals to internal or external crisis support as needed • Maintain healthy boundaries while remaining present and empathetic in all interactions • Stay current with industry trends and Society developments to align with best practices • Support innovation and outreach by engaging volunteers and modeling essential work functions across the organization

• Provides patient care modalities of evidence-based practices to best meet the clinical needs of the patients. • Review and signature of patient clinical Psychosocial assessment, diagnosis, treatment plan, and consents as needed for the patient in a timely manner. • Documents all services and patient activities appropriately. • Conducts crisis intervention for the individual and family based on the individual’s safety plan. • Participate in regular case planning with the involved Multidisciplinary Team as new information is gathered.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Care Coordinator is responsible for developing and providing care coordination services directly to Alopex clients’ patients. As an LPN Care Coordinator, you will play a pivotal role in managing and coordinating care for patients enrolled in Alopex’s services. You will work closely with patients, primary care providers, and other specialists to develop, implement, and monitor individualized care plans. Your goal is to ensure that patients receive the highest level of care through ongoing communication and coordination. - Conduct a detailed review of EMR records. - Develop and maintain individualized Care Plans for management of patients. - Implement and coordinate all care management activities relating to patients across the continuum of care. - Communicate with the patient’s clinical care team. Care management must be performed in a timely manner. - Monitor patient progress toward desired outcomes through assessment and evaluation. - Maintain accurate and detailed documentation related to medication, problems, goals, interventions, preventative care, etc. - Conduct monthly care calls to the patients enrolled in the program. - Address all needs/concerns including any follow up needed for patients. - Educate patients on chronic conditions and reinforce the provider’s directions related to chronic conditions. - Evaluate and address social determinants to health and begin to link community resources; then, enter them in the system. - Evaluate/assess medical conditions and be able to identify and address changes in a clinically appropriate manner. - Adhere to all policies & procedure as outlined by Medicare and Shifox/Alopex. - Perform other duties as assigned. Qualifications - Bilingual (English/Spanish) Required - Possess a minimum of two (2) years’ experience providing patient-centered care. - Possess a minimum of one (1) year experience in skilled nursing. - Have experience working with electronic medical records. - Can perform nursing assessments, problem identification, and care plan development. - Is adaptable to new technology – experience with computer documentation. - Has excellent time management skills. - Can assess, evaluate, and problem-solve patients’ conditions and concerns. - Possesses strong verbal and written communication skills. - Is meticulous and dedicated to providing accurate documentation. - Is dependable and focused on achieving goals. Requirements - This position is remote (please see remote requirements below). - Reliable Internet – all programs used by care coordinators are internet-based. - PC or Laptop capable of running multiple internet programs at once. - A quiet and professional work environment suitable for speaking with patients about sensitive information and Protected Health Information (PHI). Compensation $26 - $27 / hour Benefits Alopex is an equal-opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.