Careteam Plus serves the Grand Strand areas including Myrtle Beach, Georgetown, Williamsburg, Pawleys Island, and Conway, SC. We are a primary and specialty care healthcare organization providing comprehensive services for patients of all ages—from newborns to seniors. Our mission is to deliver accessible, high-quality care to all individuals, regardless of their ability to pay.

Position:

The remote patient & chronic care monitoring LPN (RPM/CCM LPN) is responsible for monitoring patient health data transmitted from patient connected medical devices and other data communicated from patient, engaging patients to support chronic disease management, and coordinating related care with providers and clinical staff. This position leverages digital health technologies, wearable devices and other data channels to monitor patients' health status and vital signs and general health remotely, allowing for continuous tracking and management of chronic conditions, post-acute care, and other medical needs. The position works closely with healthcare providers, patients, caregivers, and technology vendors to implement and maintain the overall remote monitoring system and ensure data accuracy and security. Additionally, the role focuses on chronic care management services for an established patient population. Helps manage patients with multiple chronic conditions, ensuring continuity of care, care coordination, and proactive patient engagement in compliance with established guidelines. Coaching and guiding to help close the care gap when a patient's health profile or chronic condition requires a specific clinical service, but that service has not yet occurred. Closing these care gaps to help keep chronic conditions stable, reduce emergency room visits, and improve overall health. This position is in-office (not remote) assigned M-F to the Careteam Plus Primary Care main office located at 100 Professional Park Dr. Conway, SC 29526.

QUALIFICATIONS

Experience A minimum of 6 months' prior experience with Primary Care LPN direct patient care work required. Prior experience with remote patient monitoring program service required. Prior experience with chronic care management service preferred. Experience with Athena EMR, Azara and/or SmartMeter RPM preferred. Certification, License, Registration Current and active LPN license in South Carolina (SCLLR) required (or eligibility for licensure). Current Basic Life Support (BLS) certification required. Special Skills Strong customer service focus and patient engagement skills required. Overall exemplary verbal communication skills required. Organized, flexible and able to manage competing priorities required. Evidence of sound clinical judgment and resourcefulness in problem solving required. Able to receive and follow through with delegated tasks and accountability required. High level computer skills required. Strong technical abilities required. Bilingual fluency in Spanish and English preferred. Other Must meet Careteam Plus employee health requirements for Hepatitis B and Tuberculosis screenings. Personal transportation required for usage throughout the community.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Educate patients and caregivers on the benefits of remote monitoring and care management. Monitor patients' health data and vital signs transmitted through remote monitoring devices in real-time. Review and analyze data trends, alerts, and abnormal readings to identify potential health concerns or changes in patient status. Escalate critical clinical findings and abnormal data trends to the clinical team according to clinic protocols. Coach patients on healthy lifestyle habits (nutrition, exercise, disease management, etc.). Serve as a primary point of contact for patients providing ongoing support, guidance, and encouragement. Communicate regularly with patients to reinforce adherence to monitoring protocols, address questions or concerns, and promote engagement in self-management activities. Collaborate with healthcare providers, care teams, and community resources to coordinate care for patients. Facilitate communication and information sharing among stakeholders to ensure continuity of care, timely interventions, and optimal patient outcomes. Participate in quality initiatives aimed at increasing engagement and improving care. Stay current on related CMS guidelines and organizational workflows. Maintain accurate and up-to-date records of patient interactions, monitoring activities, and outcomes using electronic health record (EHR) system. Develop and generate scheduled and ad hoc reports and summaries of data. Conduct program evaluations, and implement changes to enhance program effectiveness and efficiency over time. In general, provide chronic care management services to patients with chronic conditions. Develop, update, and manage comprehensive electronic care plans. Coordinate care with primary care providers, specialists, facilities, and ancillary services as needed. Ensure all CCM activities meet CMS, payer, and organizational compliance standards. Identify care gaps and escalate clinical concerns appropriately. Assist patients to solve barriers to care such as transportation or confusion over medication instructions. Coordinate and book necessary visits with primary care doctors or specialists. Occasionally completes primary care direct patient care, primary care nursing services in times of staff shortage. Careteam Plus staff work together as a team and help each other and patients/clients by performing other duties as assigned. Assist with patient enrollment into program(s) - Assess patients' suitability based on medical history, condition, and clinical needs. Coordinate the setup and distribution of remote monitoring devices to patients, ensuring proper installation and functionality. Provide comprehensive training to patients and caregivers on how to use remote monitoring devices, interpret data, and troubleshoot common issues. Careteam Plus is an Equal Opportunity Employer. We actively encourage applicants from diverse backgrounds and strive for staffing that reflects the diversity of the community we serve.

Job Type:

Full-time Pay:

$20.27 - $30.41 per hour Expected hours: 40.0 per week

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Employee discount Flexible spending account Health insurance Health savings account Life insurance Paid time off Referral program Retirement plan Tuition reimbursement Vision insurance

Work Location:

In person