TCHP Care Coordinator LPN - CBO Care Management - Full Time - Days

The LPN Care Coordinator serves as a key member of the care management team, supporting the RN Transition Nurse and/or Ambulatory Care Manager in coordinating patient care across the continuum. This role promotes high-quality, patient-centered care by assisting with care plan implementation, patient education, and care coordination to improve clinical outcomes and patient experience.

Education, Licensure & Certification

• Active Licensed Practical Nurse (LPN) license in the State of Ohio, with multi state licensure required

Experience & Skills

• Experience in care coordination, ambulatory care, home health, or related setting preferred
• Strong clinical knowledge, critical thinking, and organizational skills
• Effective communication and interpersonal skills
• Proficiency with electronic medical records (e.g., EPIC) and Microsoft Office (Excel, Word, PowerPoint)
• Ability to work collaboratively in a team-based, patient-centered environment

Care Management

• Care Planning & Coordination: Works under the direction of the RN Care Manager to support implementation of the established care plan. Communicates updates to individualized care plans, including referrals and follow-up care.
• Clinical Monitoring: Monitor patient status through review of labs, vital signs, and patient-reported information; escalate changes or concerns to the RN Care Manager or provider.
• Patient Education & Communication: Provide education to patients and families to support chronic disease self-management and adherence to treatment plans.
• Collaboration: Collaborates with providers, social workers, and community resources, as directed by the RN Care Manager, to ensure coordinated and comprehensive care.
• Clinical Support: Perform LPN-scope clinical tasks as appropriate, including medication reconciliation and support of care plan interventions.
• Documentation & Administrative Support: Document all patient interactions in the electronic medical record (EPIC) and support audits, reporting, and department communications (e.g., patient satisfaction outreach).

Customer Service & Patient Experience

• Deliver high-quality, patient-centered service with a focus on access, communication, and care coordination under the direction of RN Care Manager
• Foster a respectful, professional, and compassionate environment for patients, families, and colleagues
• Support a seamless patient experience through effective communication and follow-up

Information Technology & Data Management

• Maintain accurate, timely, and complete documentation in the electronic medical record
• Utilize EMR tools, registries, and population health platforms to support patient care and outreach
• Support data collection and reporting related to quality and performance metrics
• Participate in performance improvement and quality initiatives

Other Duties

• Perform other duties as assigned

Care Management

• Care Planning & Coordination: Works under the direction of the RN Care Manager to support implementation of the established care plan. Communicates updates to individualized care plans, including referrals and follow-up care.
• Clinical Monitoring: Monitor patient status through review of labs, vital signs, and patient-reported information; escalate changes or concerns to the RN Care Manager or provider.
• Patient Education & Communication: Provide education to patients and families to support chronic disease self-management and adherence to treatment plans.
• Collaboration: Collaborates with providers, social workers, and community resources, as directed by the RN Care Manager, to ensure coordinated and comprehensive care.
• Clinical Support: Perform LPN-scope clinical tasks as appropriate, including medication reconciliation and support of care plan interventions.
• Documentation & Administrative Support: Document all patient interactions in the electronic medical record (EPIC) and support audits, reporting, and department communications (e.g., patient satisfaction outreach).

Customer Service & Patient Experience

• Deliver high-quality, patient-centered service with a focus on access, communication, and care coordination under the direction of RN Care Manager
• Foster a respectful, professional, and compassionate environment for patients, families, and colleagues
• Support a seamless patient experience through effective communication and follow-up

Information Technology & Data Management

• Maintain accurate, timely, and complete documentation in the electronic medical record
• Utilize EMR tools, registries, and population health platforms to support patient care and outreach
• Support data collection and reporting related to quality and performance metrics
• Participate in performance improvement and quality initiatives

Other Duties

• Perform other duties as assigned