TCHP Care Coordinator LPN

Job description

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. 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 appr...