Bilingual Care Coordinator, LPN

🔥 4 minutes ago

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Evergreen Nephrology

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

💰 $4.3M Venture Round on 2022-06

Healthcare • Healthcare Insurance • Pharmaceuticals

Evergreen Nephrology is a company focused on transforming kidney care by empowering nephrologists to provide high-quality and personalized care to patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). By putting nephrologists at the forefront, the company provides them with financial backing, interdisciplinary clinical resources, analytical insights, and technology-enabled tools to improve patient outcomes and experience. Evergreen Nephrology collaborates with strategic partners to address healthcare challenges, including disparate electronic health records (EHRs), transplantation process visibility, and patient readmission risks. The company's co-founders, Adam Boehler and Abe Sutton, have been recognized for their contributions to kidney care models and organ procurement standards, reflecting a deep commitment to improving kidney care quality nationwide.

📋 Description

• Conduct monthly clinical check-ins • Identify and address clinical concerns • Reinforce care plans • Escalate issues appropriately • Ensure clinical documentation accuracy across both the EHR and partner technology platform • Perform monthly CCM touchpoints for assigned patient panels • Build strong, ongoing relationships with patients and caregivers through regular outreach • Review patient chart data (diagnoses, kidney disease history, medications, labs, imaging, treatment cycles) before calls • Explain CCM participation and reinforce program benefits • Conduct structured symptom assessments (pain, fatigue, neuropathy, SOB, nausea, etc.) • Evaluate changes in condition using licensed clinical judgment • Assess medication adherence issues, side effects, or confusion about regimen • Identify clinical red flags requiring escalation (e.g., worsening symptoms, new SOB, uncontrolled pain, concerning vitals) • Escalate urgent issues based on defined triage pathways (same-business-day or immediate) • Collaborate with the provider team on symptom changes, new concerns, or medication-related issues • Route EHR messages with clinically relevant documentation • Assist in coordinating care: scheduling follow-up, arranging labs, ensuring nephrology appointments are kept, and reducing missed care • Reinforce provider-developed CKD and chronic disease care plans • Provide clinical explanation of symptom management instructions (within LPN scope) • Support adherence to medications, lifestyle changes, and follow-up instructions • Identify social, behavioral, or access barriers and determine appropriate interventions or referrals • Document all patient interactions clearly in both the EHR and CCM patient management platform • Track and log qualifying CCM time accurately for billing compliance • Ensure documentation meets regulatory, internal QA, and partner expectations • Maintain high call quality and adherence to scripting and workflow pathways • Maintain or exceed: • ≥80% monthly engagement • ≥90% billable conversion • High QA/documentation accuracy scores • Participate in peer reviews, QA audits, coaching sessions, and continuous education • Identify recurring patient needs and communicate trends to the Program Manager

🎯 Requirements

• Active LPN or Licensed Vocational Nurse (LVN) license • Bilingual (Spanish/English) • Minimum 1–2 years of clinical experience in: • Ambulatory care • Population health • Care coordination • Case management • Strong clinical assessment, communication, and documentation skills. • Comfortable working in two systems (EHR + CCM platform) simultaneously. • Ability to manage a structured, metric-driven workflow with reliability. • Intermediate skills with MS Office Suite of products including Outlook and Teams • Able to work effectively in a primarily remote environment: • Home internet must support a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Cable, Fiber, or DSL connections hardwired to the internet device are recommended • Evergreen will provide remote employees with telephony applications and equipment to meet the business requirements for their role • Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

🏖️ Benefits

• Paid time off starting at 4 weeks for full-time employees • 12 paid holidays per year • Medical, dental, vision and life insurance, including an HSA with employer match • Reimbursement for continuing medical education for eligible roles • A 401(k) program where Evergreen matches up to 4% of contributions after six months of tenure • Paid parental leave • A robust training and development program that starts with onboarding and continues throughout your career with Evergreen Nephrology