SUMMARY: This role is pivotal in bridging clinical care and community resources, ensuring patients receive comprehensive support across all counties served by Axess Family Services.

LPN’s play a critical role in the delivery of quality medical care within the context of a federally qualified community health center. The LPN participates in the multi-disciplinary process of providing care and treatment to patients and provides clinical support and technical assistance to the professional medical and other staff. LPN’s are responsible for functioning within the scope of practice for their licensure or certification. They must be able to manage a demanding workload with accuracy. Position requires excellent customer service skills with patients and their families, other staff, providers, vendors, and the public. 

The Community Health Worker (CHW) provides community support services by partnering with other community agencies to help at risk / high risk individuals and their families navigate complex social service and health care systems to services to promote healthy behaviors and manage conditions that affect their health and social well-being. This culturally and geographically connected individual serves as a link between underserved communities and existing community resources. Through home visiting, these individuals assists clients in overcoming barriers to health, social services, education, and employment by performing the following duties.

SUPERVISOR: Director of Community Impact or Designee

DU­TIES AND RESPONSIBILITIES: 

LPN DUTIES:

• Perform LPN duties in accordance with state regulations and organizational standards.
• Assist with pre-visit planning to optimize patient care and provider efficiency.
• Assist with Clinic wide PREVISIT planning to address SDOH concerns
• Assist with Quality Metrics by chart review
• Coordinate scheduling on Physician scheduling availability to optimize patient success
• Connects the client to Medicaid and a medical home for preventive services within 14 days of program enrollment.
• Educates enrolled clients regarding topics such as hygiene, community groups and stress management.
• Attends training and monthly meetings and submit documentation of same to supervisor.
• Secures information such as medical, psychological, and social factors contributing to client's situation, and forwards information to clinical professionals for evaluation.
• Helps clients and families through individual or group conferences to understand, accept, and follow medical recommendations.
• Reviews care plan developed by clinical professionals and performs appropriate follow-up activities as directed.

CHW DUTIES: 

• Connects the client to Medicaid and a medical home for preventive services within 14 days of program enrollment
• Works with the clients to connect them to community social services to remove barriers to care (e.g. transportation, housing, mental health counseling, etc.).
• Interviews clients with problems such as personal and family adjustments, health, finances, employment, food, clothing, housing, utilities, and physical and mental impairments; completes appropriate checklist; and brings information back to agency clinical professionals to determine nature and degree of problem.
• Enters information from home visits into database in an accurate and timely manner. 
• Accesses and records client’s and community’s resource information in required system.
• Advocates for client and acts as a liaison between client and other service providers.
• Counsels client individually, in family or other small groups, regarding plans for meeting needs and aids client to mobilize inner capacities and environmental resources to improve social functioning.
• Secures supplementary information such as employment or medical records or school reports as directed.
• Determines client's eligibility for services such as financial assistance, insurance and other programs in place to assist individuals and refers clients to community resources and other agencies to meet identified needs.

The Duties and Responsibilities above represent the most significant duties of this position, but do not exclude other assignments that would be within the qualification and responsibility levels of this position. 

MINIMUM QUALIFICATIONS:

• Required  -5 years LPN experience
• Required  – CHW certification or willing to obtain certification within 12 months of      hire.
• Required  – Reliable transportation
• Excellent  communication skills
• Excellent organizational skills
• Must  be able to work independently with a proven track record
• Ability to work in diverse communities and among different races, cultures and      classes
• Ability and willingness to provide emotional support, encouragement and motivation      to patients
• Familiarity with resources available within the community

LICENSES OR CERTIFICATIONS REQUIRED: 

• Unrestricted  State of Ohio LPN Licensure
• Unrestricted  State of Ohio driver’s license

COMPLIANCE: 

This position requires compliance with AFS’ written standards, including its Compliance Program and Standards of Conduct and policies and procedures. Such compliance will be an element considered as part of the regular performance evaluation.

Failure to comply with AFS’ Written Standards, which may include the failure to report any conduct or event that potentially violates legal or compliance requirements or AFS’ Written Standards or, for managers and supervisors, fails to detect non-compliant conduct where reasonable efforts would have resulted in detection, will be met by the enforcement of disciplinary action, up to and including possible termination, in accordance with AFS’ Compliance Program Policy and Procedure: Addressing Instances of Non-Compliance through Appropriate Disciplinary Actions.

PHYSICAL DEMANDS: 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 

While performing the duties of this job, the employee is regularly required to sit, and use hands to finger handle or feel; to talk; or hear. The employee is frequently required to reach with hands and arms. The employee must occasionally stand, walk, climb or balance, stoop, kneel, crouch or crawl. The employee must be able to frequently lift up to 25 pounds. The employee may occasionally be required to lift 25 to 50 pounds; however, this is not essential; duties may be shifted to accommodate lifting restrictions.
 

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to use close vision (clear vision at 20 inches or less). The employee will occasionally be working near moving mechanical parts, be exposed to outdoor weather conditions and exposed to a risk of electrical shock while running the copier, printer, other standard equipment and answering the telephone. The noise level in the work environment is low to moderate. Stress level can be high at times.

 

Note: This job description is not intended to be an exhaustive list of all duties, responsibilities or qualifications associated with the job.