Care Manager - LPN

Epic Health System Llc•Southfield, MI

7d•Remote

About The Position

The LPN Care Manager supports chronic care management and population health initiatives by providing clinical outreach, patient education, care coordination, and documentation under the direction of a Care Management Supervisor or Team Lead. This role focuses on improving patient engagement, adherence, and health outcomes for patients with chronic conditions.

Requirements

Active Licensed Practical Nurse (LPN) license in good standing.
Clinical experience in ambulatory care, primary care, chronic disease management, or care coordination.
Strong communication, patient engagement, and organizational skills.
Proficiency with Electronic Health Records (EHR) and Microsoft Teams or similar technology platforms.
All duties are performed within the LPN scope of practice and under appropriate supervision.
Clinical decision-making, diagnosis, treatment modifications, and complex patient concerns are escalated to the Care Manager, Team Lead, or provider as appropriate.
Background checks are required for this role.

Nice To Haves

Previous Care Management, Chronic Care Management (CCM), or Population Health experience.
Knowledge of value-based care models and quality programs.
Experience working with diverse patient populations and chronic disease management programs.

Responsibilities

Conduct scheduled outbound and inbound patient calls.
Perform monthly care management touchpoints according to program requirements.
Assess patient needs, symptoms, medication adherence, and barriers to care.
Engage patients in goal setting, self-management, and health improvement activities.
Monitor chronic conditions such as diabetes, hypertension, congestive heart failure (CHF), and COPD.
Reinforce provider care plans and evidence-based treatment recommendations.
Identify clinical concerns and escalate red flags to the appropriate provider, Care Manager, or Team Lead.
Support transitions of care, including post-hospitalization and emergency department follow-up.
Perform medication reconciliation and adherence reviews.
Educate patients on medication purpose, dosing, and potential side effects within LPN scope of practice.
Identify gaps in preventive care and chronic disease monitoring.
Assist with scheduling appointments, laboratory testing, and specialist referrals.
Coordinate care with providers, care managers, social workers, and external healthcare partners.
Address social determinants of health and connect patients with appropriate community resources.
Accurately document all patient interactions within the Electronic Health Record (EHR).
Ensure documentation meets Chronic Care Management (CCM), payer, and regulatory requirements.
Track patient eligibility, consent, and monthly billing requirements.
Maintain HIPAA compliance and patient confidentiality at all times.
Meet established productivity, quality, and caseload expectations.
Participate in team huddles, audits, and performance improvement initiatives.
Follow departmental workflows, policies, and timelines.

Benefits

Competitive compensation
Medical, Dental, and Vision Insurance
401(k) Retirement Plan
Paid Time Off and Paid Holidays
Short-Term Disability, Long-Term Disability, and Life Insurance
Employee Assistance Program (EAP)
Professional development and career advancement opportunities
Ongoing training and support in Care Management and Population Health
Collaborative, team-oriented work environment
Opportunity to work in a growing organization focused on improving patient outcomes