• The LPN Care Coordinator will be responsible for delivery of Transitional Care and Chronic Care Management services allowing patients to thrive and progress toward desired outcomes. • Responsibilities include post-discharge patient outreach, patient-centered care plans, and service coordination utilizing software tools that facilitate communication and exchange of information with patients, CRC providers, and other care team members. • Detailed review of EMR record to inform initial outreach and care plan areas of focus • Perform comprehensive assessments for both physical and psychosocial risk factors that support individual patient needs while identifying and addressing barriers • Communicate assessment findings, care plan goals, interventions and outcomes to provider, patients, and caregivers in a timely manner • Monitor patient’s ED visits and acute stays, perform post-discharge follow up calls and continuously assess risk of readmissions post-discharge • Utilize motivational interviewing to promote patient engagement and empower patient to develop self-management skills • Provide chronic disease education and symptom management teaching to patients and caregivers • Communicate proactively with provider to address patient change in status or obtain any necessary referrals/orders • Document care plans, clinical interventions, and outreach in care management software system • Develop and maintain effective professional working relationships with assigned providers and other care management team members

• The LPN Care Coordinator will be responsible for delivery of Transitional Care and Chronic Care Management services allowing patients to thrive and progress toward desired outcomes. • Responsibilities include post-discharge patient outreach, patient-centered care plans, and service coordination utilizing software tools that facilitate communication and exchange of information with patients, CRC providers, and other care team members. • Detailed review of EMR record to inform initial outreach and care plan areas of focus. • Perform comprehensive assessments for both physical and psychosocial risk factors that support individual patient needs while identifying and addressing barriers. • Communicate assessment findings, care plan goals, interventions and outcomes to provider, patients, and caregivers in a timely manner. • Monitor patient’s ED visits and acute stays, perform post-discharge follow up calls and continuously assess risk of readmissions post-discharge. • Utilize motivational interviewing to promote patient engagement and empower patient to develop self-management skills. • Provide chronic disease education and symptom management teaching to patients and caregivers. • Communicate proactively with provider to address patient change in status or obtain any necessary referrals/orders. • Document care plans, clinical interventions, and outreach in care management software system. • Develop and maintain effective professional working relationships with assigned providers and other care management team members.

• Be responsible for providing first-level support to internal users of Beep's technology platform, including support for operational systems and sales platforms. • Assist users who are having difficulty with specific tasks that may impact our operations. • Execute scripts in the production environment. • Provide user incident resolution support. • Escalate and hand off issues to other service levels when necessary. • Document occurrences and resolve all incidents.

• Download and listen to classes for which hired • Produce clear, thorough typed notes by specified deadline/turnaround time