Position Highlights
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Department: MHPC Population Health
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Hours: 40.00 per week
Position Summary
The LPN – Medicare Annual Wellness Visit Coordinator is responsible for participating in conducting Medicare Annual Wellness Visits (AWVs) at all Middlesex Health Primary Care (MHPC) practice locations, in collaboration with a licensed provider. This role focuses on preventive care, health risk assessments, patient education, care gap identification, and accurate documentation to support high-quality, compliant Medicare services. The nurse works under established protocols and in coordination with providers to ensure comprehensive, patient-centered care.
Essential Duties & Responsibilities
Clinical and Patient Care:
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Perform Medicare Annual Wellness Visit components as directed by provider and in accordance with CMS guidelines
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Conduct and document Health Risk Assessments (HRA)
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Collect and document in health system electronic medical record (EMR) the required patient information, including:
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Medical, surgical, family, and social history
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Medication lists
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Allergies
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Providers Care Team participants and suppliers involved in the care of the patient
Required Screenings and Assessments:
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Obtain and document vital signs and other required clinical data
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Perform standardized screenings, including but not limited to:
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Depression screening
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Cognitive impairment assessment support
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Fall risk and safety assessment
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Functional ability and activities of daily living (ADL/IADL) screening
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Identify health risks and report findings to the provider for clinical decision-making
Preventive Care and Care Coordination:
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Identify preventive care gaps (e.g., immunizations, screenings, labs)
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Provide patient education related to preventive services, screenings, immunizations, and lifestyle risk factors
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Coordinate follow-up appointments, referrals, and orders as directed by the provider
Documentation, Billing Support and Compliance:
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Accurately document all AWV components in the EMR
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Ensure documentation supports Medicare billing and compliance requirements:
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Follow established clinical protocols, workflows, and standing orders
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Maintain patient confidentiality and comply with HIPAA and organizational policies
Collaboration and Quality Support:
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Communicate findings, concerns, and care gaps to the applicable primary care provider in a timely manner
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Work collaboratively with providers, care teams, and administrative staff to support AWV scheduling and completion
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Participate in training, quality improvement initiatives, and workflow optimization related to AWVs
Minimum Qualifications
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Active, unrestricted LPN license in Connecticut
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Graduate of an accredited nursing program
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BLS certification
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2+ years experience in an ambulatory or primary care setting
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Proficiency with electronic medical records (EMR) and standardized documentation tools
Preferred Qualifications
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Experience performing or supporting Medicare Annual Wellness Visits
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Knowledge of CMS guidelines and preventive care measures
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Experience with population health or quality-based care models
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EPIC experience
Comprehensive Benefits Offered
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Competitive and affordable benefits package
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Shift Differentials
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Continuing Education assistance
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Tuition reimbursement
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Student Loan relief through Fiducius
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Quick commute access from I-84, Route 9 and surrounding areas
About Middlesex Health
The Smarter Choice for your Career!
Come join one of Connecticut’s Top Workplaces, and a Magnet designated organization! At Middlesex Health, we have a unique combination of award-winning talent, world-class technology, and patient-first care that's making health care better. Through our affiliation with the Mayo Clinic Care Network, Middlesex Health has access to the most advanced medical knowledge and research available.