LPN Service Coordinators are members of the Assertive Community Treatment (ACT) team who provide flexible, community based services that are designed to promote the health, stability, recovery and community reintegration of formerly homeless individuals who have a mental illness and abuse substances. The LPN Service Coordinator (LPN SC) maintains a primary caseload of 10-12 clients, provides primary health care to consumers on the team, and in collaboration with the transdisciplinary team coordinates and provides ACT services for all clients on the team in a compassionate and responsible manner.

RESPONSIBILITIES:

• Collaborate with client in the formulation of an Individual Recovery Plan (IRP) that is reviewed and modified with client on a regular basis;
• Provide outreach, case management, counseling, advocacy, and other needed services to clients in any environment including: streets, shelters, jails, hospitals, apartments, office, etc; 80% of contact with clients is field-based;
• Provide individually tailored services to each client for: housing, education & work opportunities, activities of daily living, health, wellness self-management, relapse prevention, money management & entitlements, medication support, self help & empowerment, problem solving, family life & social relationships and integrated treatment for substance abuse;
• Maintain written and electronic records, compile reports and complete program

• Provide administrative assistance to ACT Team RN, medical team and medical director;
• Administer IM injections per medical orders;
• Coordinate with office-based LPN and Team RN to ensure that medication deliveries are signed for, checked, and packed for delivery, per schedule determined by the Team and RN.
• Coordinate with office-based LPN to maintain/update medication administration forms in team binders monthly
• Maintain/update consumer medical profile, PCP, vitals, diagnoses and record of recent medical visits
• Proactively follow up on health and wellness indicators (take blood pressure, blood sugar, height and weight (BMI) in the community.
• Collaborate with other health care providers and make appropriate referrals;
• Monthly Medication/Treatment review of team charts and update as per direction from team nurse, including completion of the ACT Monthly Notes;
• Teach health promotion to consumers and staff;
• Advocate for consumers in accessing and navigating the heath care system;
• Collaborate with staff to coordinate prescriptions and orders;
• Participate in facilitating appropriate hospitalizations (medical and psychiatric), crisis interventions and referrals;
• Communicate with hospital staff to ensure optimal treatment and discharge planning;
• Serve as contact person for outside providers and provider relations (pharmacy, Pharmaceutical reps, MD/HHA, etc)
• Assist with procurement of medical/nursing supplies;
• Ensure timely administration of injections and/or blood work;
• Provide education updates/reminders to nursing staff;
• During morning meeting perform regular checks on status of establishing PCP relationship for each client;
• Follow up on monthly hospitalizations;
• Generate 4.5 hours of Medicaid billable services each work day;
• Coordinate and monitor referrals to community services and advocate client participation;
• Lead groups, workshops, and in-services on topics relevant to identified areas of client need;
• Participate in on-call rotation;
• Perform other related work as assigned;

• EDUCATION- Must have successfully completed all education and training requirements leading to and graduated from an accredited national, state or military equivalent school for Practical Nursing.
• LICENSE- Must have and maintain throughout course of contract, a current, active, valid, unrestricted license (with no limitations, stipulations or pending adverse actions) to practice as a Licensed Practical Nurse (LPN) from a US jurisdiction. License must be recognized and accepted by the DC Department of Health in accordance with governing regulations.
• Patience, creativity, flexibility, compassion, and sensitivity to persons with disabilities and other minority populations;
• Excellent communication, writing, and computer skills;
• Drivers License required;
• KNOWLEDGE: As appropriate within established procedures, protocols and scope of practice, must have understanding of and ability to correctly utilize and/or apply; medical terminology, anatomy and physiology, psychology, pharmacology, medical ethics and legal concepts, clinical procedures, patient care; emergency medical treatment to include cardiopulmonary resuscitation, specimen collection, diagnostic testing, prepare and administer oral and parenteral (excluding IV) medications, vaccination procedures, mechanisms of anaphylaxis and shock and their treatment; prescription drugs and their administration; operating and maintaining therapeutic equipment, risk management, medical contingency operations, computer operations in the use of basic word processing, data entry and automated medical records.
• EXPERIENCE: Experience performing care and treatment of patients; experience working in a team-based setting; operating and maintaining therapeutic equipment; properly administering oral and parenteral medications; conducting paraprofessional portions of physical examinations; or assisting in medical treatment of patients in accordance with established procedures and protocols, within the LPN scope of practice.

• 2 years work experience in social services, supported housing, and/or persons with psychiatric disabilities;
• Has practiced as an LPN performing hands-on patient care in the outpatient clinical setting for at least 12 months within the past 24 months.
• Familiarity with Medicaid billable note writing;
• Bilingual English/Spanish a plus;