Full Job Description
About Seen Health
At Seen Health, we are revolutionizing the way senior care is delivered through the PACE (Programs of All-Inclusive Care for the Elderly) model. Backed by top VCs, Seen Health is a culturally-focused, technology-enabled healthcare organization that integrates comprehensive medical care and social support with a high-touch, interdisciplinary approach.
Our mission is to empower seniors to age-in-place with dignity and provide their families peace of mind. We are building upon a proven Home and community based services model to create a culturally-competent and scalable PACE program. We are also building a comprehensive operating system focused on data and workflows that span across systems, processes, people, and care contexts. We want to empower our clinicians and staff with tools that deliver relevant data at the time and site of care and enable them to deliver exceptional care to our participants, which improve clinical outcomes, participant & provider satisfaction, and ultimately our strength as an organization.
We are a mission-driven, multidisciplinary team with deep healthcare, technology, and operations expertise, each inspired by our own personal stories of caring for seniors in our lives. Our name, Seen Health, was chosen to reflect our commitment to provide the highest standard of care to underserved older adults while respecting and incorporating their individual beliefs, heritage, and values, so that they can truly be seen.
Responsibilities
- Triage inbound communications, including calls, faxes, email and instant messages from teammates, patients and partners and prioritize patient needs, including care coordination and medical treatment by assisting with wound care, IV therapies, and other clinical procedures within scope of practice.
- Serve as a communication link among patients, PCPs, and healthcare professionals, assists Clinic Manager, as needed, to provide on-site instruction to Personal Care Assistants/CNAs and Licensed Vocational Nurses (LVNs).
- Oversee post-appointment processes, including diagnostic orders (EKGs, POC testing, labs), referrals, and medication orders and management.
- Engage in comprehensive chart preparation and provide crucial patient education on care plan adjustments.
- Develop a plan of care based on the nursing process, which incorporates the plans of other disciplines and continuing care needs, and includes the patient and family in developing or revising the plan of care.
- Vaccinate and educate participants about need for routine vaccinations, if needed.
- Educate the participant, family, and caregivers regarding the chronic disease process, self-care techniques, and prevention strategies.
- Assess participants’ physical and mental wellness, needs, preferences, goals and abilities, ensuring that coordinated care reflects participant wishes and consent.
- Performs authorized nursing and case management services in participant home , as needed e.g. wound care, vaccine or medication administration, etc.
- Support RN team and home care LVN to complete home care and pre-enrollment level of care assessments as needed.