Lpn Case Manager

Job Summary:

The Licensed Vocational Nurse (LVN) / Licensed Practical Nurse (LPN) Case Manager provides support to the Transitions of Care program focused on reducing 30-day hospital readmission rates. Working under the direction of an RN Care Manager, the LPN assists with implementing care plans through appointment scheduling, biometric data monitoring, patient education, home visits, and connecting patients with community resources. This role requires strong communication, documentation skills, and the ability to work independently as part of a multidisciplinary care team managing a caseload of approximately 25 30 patients.

• Support the Transitions of Care program to reduce 30-day readmission rates.
• Assist RN Care Manager in implementing patient care plans.
• Schedule appointments and monitor biometric data.
• Provide and reinforce patient education related to care plans and medication adherence.
• Conduct home visits, attend patient visits as needed, and maintain frequent patient contact.
• Connect patients with appropriate community resources and services.
• Document patient information and care activities accurately in the electronic health record (EHR).
• Participate in multidisciplinary care team rounds to provide patient updates.
• Manage a monthly rolling caseload of approximately 25 30 patients.
• Work collaboratively with RN, Social Worker, Pharmacist, and other team members.

• Current licensure as a Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) in the state of practice.
• Basic Life Support (BLS) certification.
• Minimum of 1 year of nursing experience, preferably in home health, case management, or related settings.
• Strong clinical knowledge, especially related to CHF, COPD, and complex comorbidities preferred.
• Excellent communication and documentation skills, including proficiency with electronic health records (EHR).
• Reliable transportation for travel to patient homes, hospitals, and provider offices.
• Ability to work independently and manage multiple tasks efficiently.

• Experience with care coordination and community resource linkage.
• Prior experience in a multidisciplinary care team environment.
• Knowledge of chronic disease management and patient education techniques.

• This is a mobile position requiring travel to patient homes, hospitals, and provider offices.
• Not a hands-on nursing role; focus is on case management and care coordination.
• Participation in virtual care team rounds and telephonic patient follow-up is required.
• Must maintain flexibility throughout the workday to accommodate patient and team needs.

• Full-time position, Monday through Friday, 8:00 a.m. to 4:30 p.m.
• 40 hours guaranteed weekly.
• No weekend or on-call shifts required.