Licensed Practical Nurse (LPN) – Chronic Care Management (CCM)

The ideal candidate is an organized, tech-savvy LPN who communicates well with patients and is comfortable working extensively within an electronic medical record system. Candidates with home health, hospital, skilled nursing facility (SNF), or similar high-volume clinical experience are encouraged to apply.

Essential Duties and Responsibilities

• Conduct patient outreach and follow-up as part of the Chronic Care Management program.
• Communicate with patients regarding ongoing care needs, medications, appointments, treatment plans, and health concerns within the LPN scope of practice.
• Support the coordination of care for patients with chronic medical conditions.
• Review patient information and communicate relevant changes or concerns to the appropriate RN, provider, or member of the clinical team.
• Assist patients with navigating appropriate follow-up care and appointments.
• Document patient interactions, care coordination activities, and relevant clinical information accurately and thoroughly in the electronic medical record (EMR).
• Maintain timely and accurate patient records.
• Work collaboratively with RNs, providers, and other members of the CCM and clinical teams.
• Follow established workflows and escalation procedures for patient concerns.
• Provide professional, compassionate, and effective communication during telephone interactions with patients.
• Maintain patient confidentiality and comply with HIPAA and organizational policies.
• Perform additional duties as assigned based on departmental and organizational needs.

Minimum Qualifications

• Current and unrestricted Licensed Practical Nurse (LPN) license.
• Minimum of one (1) year of professional LPN experience.
• Strong verbal and written communication skills.
• Strong organizational skills and attention to detail.
• Comfortable learning and utilizing technology and electronic medical record systems.
• Ability to manage multiple patient interactions, follow-ups, and documentation requirements efficiently.
• Ability to work collaboratively within a multidisciplinary healthcare team.

Preferred Qualifications

• Previous Chronic Care Management (CCM) or care coordination experience.
• Home health experience.
• Hospital experience.
• Skilled Nursing Facility (SNF) experience, particularly in a fast-paced or clinically rigorous environment.
• Experience providing patient support or clinical communication by telephone.
• Strong proficiency with electronic medical record (EMR) systems.