LVN Care Coordinator: Population Health & Transitions

Jobtome; Tyler (TX); On-site; USD 52,000 - 70,000; Full time

Job summary

Jobtome is seeking a licensed Vocational Nurse (LVN) to provide care under the Population Health Director of Care Management or Nurse Manager. You will coordinate with physicians and the outpatient care team to improve health outcomes, reduce hospital admissions, and prevent readmissions for high-risk patients with complex conditions.

You will collaborate with Nurse Navigators on transition of care, identify care gaps, and engage patients and families to follow recommended protocols and testing.

Qualifications

• LVN license required (state of employment or compact).

Responsibilities

• Manages a case load in collaboration with the health care team.
• Coordinates preventive/follow-up care using physician-approved protocols.
• Reviews patient records to identify care gaps.
• Documents encounters and schedules needed services.
• Facilitates communication among patient, caregiver, PCP, and care team.
• Assists with transitions of care outreach after discharge.
• Promotes patient engagement using education and behavioral strategies.
• Maintains confidentiality and complies with CEU requirements.
• Works closely with Nurse Navigators to ensure medical stability.

Skills

Care coordination

Communication

Team collaboration

Education

LVN license

Job description

Jobtome is seeking a licensed Vocational Nurse (LVN) to provide care under the Population Health Director of Care Management or Nurse Manager. You will coordinate with physicians and the outpatient care team to improve health outcomes, reduce hospital admissions, and prevent readmissions for high-risk patients with complex conditions.

You will collaborate with Nurse Navigators on transition of care, identify care gaps, and engage patients and families to follow recommended protocols and testing.