Job Description

Job Description

Job Description

LPN Care Coordinator – Cleveland, OH

Type: Full-time, On-site
Setting: Small Primary Care Clinic (NP, LPN, MA team)

About the Role

We’re seeking a Licensed Practical Nurse who thrives in a collaborative, patient-centered environment. This role is at the heart of ensuring patients—especially those with chronic conditions, recent hospital discharges, or complex needs—don’t fall through the cracks. You’ll connect the dots between patients, providers, and community resources to keep care continuous and outcomes strong.

What You’ll Do

Care Coordination & Navigation

• Conduct pre-visit planning and outreach to close care gaps (A1C, screenings, immunizations).

• Perform 24–72-hour post-discharge calls, medication reconciliation, and schedule follow-ups.

• Manage referrals, prior authorizations, and coordinate with specialists and payers.

• Develop, update, and track individualized care plans in the EHR.

• Connect patients to community resources such as transportation and social services.

• Perform health risk assessments and support remote patient monitoring.

Clinical Support (as needed)

• Room patients, take vitals, and perform point-of-care testing (A1C, UA, Accu-Chek, hemoglobin/iron).

• Assist with wound care, ear washes, Retinaview exams, and lab draws.

Communication & Problem-Solving

• Triage inbound calls and escalate when appropriate.

• Coordinate with labs, home health, and specialists while keeping patients informed.

• Identify risks early and propose proactive solutions.

Quality & Documentation

• Maintain accurate, timely EHR documentation.

• Help refine workflows and dashboards that improve coordination and efficiency.

What Success Looks Like (First 90 Days)

• 95%+ post-discharge calls completed within 72 hours.

• Improved performance on gap-closure measures (A1C control, retinal screenings, statin use).

• Referral loop closure rate above 85% within 14 days.

• Reduced patient no-shows through coordinated reminder and transportation workflows.

• Clean, timely documentation across all assigned patients.

What You’ll Bring

• Active Ohio LPN license in good standing.

• 3–5 years of care coordination experience in primary care, care management, or similar settings.

• Strong bedside nursing background.

• Excellent critical thinking, prioritization, and communication skills.

• Comfort using EHRs, registries, and simple data tracking tools.

• Stable, progressive work history with clear reasons for transitions.

Preferred:

• Experience with Medicare/Medicaid or value-based care models.

• Familiarity with community resources in the Cleveland area.

• Background in building coordination workflows or dashboards.

Role Details

• Location: Cleveland, OH (on-site)

• Schedule: Weekdays, generally 8:00 AM–4:30 PM (some flexibility for patient outreach)

• Reports To: Nurse Practitioner/Clinic Lead and Practice Manager

• Compensation: Competitive salary and benefits; details shared early in the process

Equal Opportunity Employer.
We celebrate diversity and are committed to creating an inclusive environment for all employees.

Job Tags

Similar Jobs