LPN Transitional Care Coordinator (Prince Georges County, MD)

LPN Transitional Care Coordinator (Prince Georges County, MD) Ennoble Care is a mobile primary care, palliative care, and hospice service provider that brings clinicians to patients' homes across multiple states, including Maryland. We provide continuous support for individuals with chronic conditions and limited mobility. About the Role We are seeking a full‑time Licensed Practical Nurse (LPN) to serve as a Transitional Care Coordinator on‑site at partnered long‑term care facilities in Prince George's County, Maryland. The role involves monitoring patient condition, coordinating care transitions, and collaborating with our clinical team and facility staff to keep patients healthy and reduce unnecessary hospitalizations. Required Qualifications Legally authorized to work in the United States Active, unrestricted LPN license in Maryland Minimum 1 year of patient‑facing experience in a long‑term care, skilled nursing, or transitional care setting Proficient in Microsoft Office (Excel, Outlook, Word, Teams) and Microsoft Teams communication Knowledge of healthcare terminology and care coordination principles Strong clinical assessment skills and ability to identify and raise changes in condition Experience with EMR systems; PointClickCare preferred Excellent communication, interpersonal, and organizational skills Capacity to work independently and as part of a multidisciplinary team Full‑time on‑site availability 5 days per week; flexible weekdays, weekends preferred; daytime hours (8:00 a.m. – 4:30 p.m. EST), no evenings or overnight shifts, no on‑call Ability to pass background check and drug screen Valid driver’s license, reliable transportation, and current auto insurance Key Responsibilities Co‑ordinate care for residents in skilled nursing and rehabilitation facilities using Ennoble Care’s EMR Initiate transitional care management immediately after patients are discharged from hospital and expedite first provider visit following guidelines Monitor patients and communicate changes in condition promptly to providers, initiating appropriate interventions and escalating care when clinically indicated, including CCM‑billable activities Maintain a consistent on‑site presence to build relationships with residents and families, reinforcing trust and continuity of care Perform vital sign collection and routine patient check‑ins to support care plans and clinical stability Act as a key liaison among Ennoble Care providers, facility staff, residents, families, and the Housecalls division Document patient interactions, assessments, and care coordination activities accurately in the EMR and reconcile charts with facility records Support onboarding and training of new Transitional Care Coordinators, serving as a mentor and resource Work Environment & Expectations Embedded on‑site role within assigned skilled nursing or rehabilitation facilities Consistent daily presence and strong relationship‑building with facility staff Fast‑paced, patient‑facing environment requiring clinical judgment, adaptability, and proactive engagement Compensation & Benefits Starting salary: $55,000 annually Quarterly bonus opportunities based on performance Eligibility for mileage reimbursement when traveling between facilities Full‑time health benefits including medical, dental, vision, life insurance, short‑term and long‑term disability, flexible spending accounts, and elective benefits Paid time off, paid office holidays, paid sick time; 401(k) with up to 3% company match; referral program; PayActiv pay‑on‑demand option #J-18808-Ljbffr Ennoble Care