Licensed Vocational Nurse

Job Description

Job Description

The LVN Community Care Coordinator plays a vital role in delivering comprehensive care coordination and in-home support for patients with complex medical, behavioral, and social needs. This proactive, multi-disciplinary approach ensures improved quality of life, health literacy, and care outcomes while reducing medical costs. The role combines clinical expertise, compassionate patient engagement, and collaboration with a diverse care team to address the holistic needs of patients in the community.

This position requires travel to San Diego, throughout San Diego County, and surrounding areas to provide in-home support to our patients. 

DUTIES & RESPONSIBILITIES

• Conduct in-home care visits to assess patient conditions and chart observations in the electronic medical record (EMR).

• Perform vital signs checks, collect medical history, conduct medication reconciliation, and report findings to the patient’s provider.

• Provide education and support on chronic illness management, safe medication use, and general self-care practices.

• Deliver palliative care as needed to enhance patient comfort and quality of life.

• Conduct home safety evaluations and make recommendations for devices or tools to improve patients' daily living.

• Collaborate with multidisciplinary teams, including physicians, occupational therapists, physical therapists, and social workers, to execute care plans effectively.

• Engage in community outreach to connect patients with necessary services and resources, assisting with enrollment as needed.

• Actively participate in bi-weekly panel management and clinical rounds.

• Perform phlebotomy, venipuncture, and specimen preparation for lab analysis.

• Provide emotional support, stress management education, and guidance on managing dietary concerns.

• Document all care coordination activities accurately in the EMR, ensuring compliance with HIPAA regulations.

• Travel to multiple patient homes or designated locations daily, including shelters, transitional housing, and assisted living facilities.

• Act as a liaison between patients and healthcare providers, explaining care plans and addressing concerns.

• Support outreach teams in locating and engaging patients who are difficult to reach.

• Adapt to changing policies, procedures, and responsibilities as needed.

• Other duties as assigned. 

SKILLS & QUALIFICATIONS

• Minimum of 1 year of experience as an LVN, preferably in an outpatient, home health, or public health setting.

• Experience in caring for elderly or chronically ill patients is preferred.

• Strong organizational, communication, and time-management skills.

• Knowledge of HIPAA regulations and commitment to maintaining patient confidentiality.

• Ability to work independently while collaborating within a multidisciplinary team.

• Proficiency in Microsoft Office Suite.

• Proficiency in electronic health records (EHR) systems.

• Bilingual in English/Spanish is preferred.

• Must be able to travel up to 40% across the assigned geography.

EDUCATION, LICENSES, & CERTIFICATIONS

• Graduate of an accredited nursing program with a valid Licensed Vocational Nurse (LVN) license in California is REQUIRED. 

• CPR/BLS certification (AHA for healthcare providers).

• Certified phlebotomy skills are highly desirable.

• Annual TB testing. 

• Unrestricted driver’s license.