Care Navigator (RN/LPN) for Chronic Disease & Transitions

Southwest Virginia Community Health Systems; Bristol (VA); On-site; USD 28,000 - 36,000; Full time

Benefits offered by this job

Health, dental, and vision coverage

Group Term Life insurance

Voluntary Life Insurance

Voluntary Accident, Hospital Indemnity

Critical Illness, Short Term & Long >

Job summary

Southwest Virginia Community Health Systems, Inc. (SVCHS) seeks an experienced Care Coordinator (RN or LPN) to join our multidisciplinary primary care team in the Virginia region. The role focuses on coordinating care for high-risk patients and those with chronic illnesses within a PCMH environment.

The Care Coordinator will partner with patients, families, providers, and community resources to reduce avoidable hospital visits, improve care continuity, and support population health initiatives.

Qualifications

• Current, unrestricted license to practice as an RN or LPN.
• Minimum of five years of relevant healthcare experience.
• Experience with care coordination, case management, discharge planning, transitional care, or chronic disease management.
• Proficiency with Microsoft Office and EMR systems.

Responsibilities

• Population health and chronic disease management using EMR, registries, and risk assessments.
• Care coordination and transitional care including referrals and follow-up.
• Patient education and health coaching to support self-management.
• Team and organizational responsibilities including documentation and HIPAA compliance.

Skills

Care coordination

Case management

Discharge planning

Transitional care

Chronic disease management

EMR familiarity

Microsoft Office

Education

RN or LPN license

Tools

EMR systems

Job description

Southwest Virginia Community Health Systems, Inc. (SVCHS) seeks an experienced Care Coordinator (RN or LPN) to join our multidisciplinary primary care team in the Virginia region. The role focuses on coordinating care for high-risk patients and those with chronic illnesses within a PCMH environment.

The Care Coordinator will partner with patients, families, providers, and community resources to reduce avoidable hospital visits, improve care continuity, and support population health initiatives.