Imagine a career at one of the nation's most advanced health networks.

Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

**This is a remote position however some in-person work may be required at the discretion of the department**

Summary
Implements care plans that are specific to each patient's physical, mental, and social and medical needs. Ensures smooth transitions and evidence-based disease management for select populations. Works collaboratively as part of a multi-disciplinary team to provide patient and family education and navigation across the continuum of care.

Job Duties

• Collaborates with Post-Acute facility to optimize patient navigation through care continuum
• Identifies patients not meeting clinical goals or important quality metrics and arranges follow-up, as appropriate.
• Collaborates with patient/family in establishing mutual goals based on the patient's needs and problems.
• Identifies issues related to the healthcare system, transportation, financial, and/or psychological barriers and works collaboratively to problem solve, coordinate services, and advocate for patients/families.
• Reviews and updates medication list and accurately documents known allergies in the electronic health record (EHR) at discharge to community from post-acute facility.
• Supports post-acute and LVHN in mutual quality improvements, pilot participation, and other research activities.
• Evaluates all readmissions using standard tool in collaboration with post- acute facilities and network.
• Identifies actual or potential variances in standards of care and system problems that could lead to errors, delays in care, complications, or increased cost.

Minimum Qualifications

• Specialized Diploma Registered Nurse or
• Master’s Degree Physical Therapist or
• Master’s Degree Occupational Therapist
• 3 years Post-Acute Care and
• 3 years Electronic Medical Record (EMR)
• RN - Licensed Registered Nurse_PA - State of Pennsylvania or
• PT - Licensed Physical Therapist - State of Pennsylvania or
• OT - Licensed Occupational Therapist - State of Pennsylvania

Preferred Qualifications

• Associate’s Degree Registered Nurse or
• Bachelor’s Degree Registered Nurse
• Ability to network and establish strong relationships with post-acute facilities/agencies.
• Ability to integrate into facility interdisciplinary team cohesively and collaboratively.
• Ability set priorities to coordinate care plan efficiently.
• Utilizes effective strategies for interacting with persons from diverse backgrounds.
• Ability to recognize the role of cultural, social, economic, and behavioral factors in accessibility, availability, acceptability, and delivery of public health services.
• Knowledge of computer applications and analytical tools.

Physical Demands
Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

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Lehigh Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases, our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes.