Licensed Practical Nurse, Primary Care

Monarch•Rocky Mount, NC

18h•Hybrid

About The Position

The Licensed Practical Nurse (LPN) / Care Coordinator supports the delivery of integrated primary care services within a behavioral health setting. This position provides direct clinical nursing support while coordinating care across physical health, behavioral health, specialty care, community resources, and social services. The LPN serves as a key member of the interdisciplinary care team, helping patients navigate the healthcare system, improve chronic disease management, increase preventive care utilization, and reduce barriers to achieving optimal health outcomes. The ideal candidate is passionate about whole-person care and demonstrates strong skills in patient engagement, care coordination, chronic disease management, and collaboration with behavioral health providers.

Requirements

High School Diploma (Required)
Basic Life Support (BLS) - American Heart Association (AHA) or American Red Cross (ARC)
Licensed Practical Nurse (LPN) - State Board of Nursing
Experience in a primary care practice setting. | 1 Year | Not Required
Experience in primary care, family medicine, community health, behavioral health, care management, or population health | Not Required
Experience working with Medicaid, Medicare, and underserved populations | Not Required

Responsibilities

Perform patient intake, rooming, and visit preparation.
Obtain and document vital signs, height, weight, BMI, tobacco use status, and relevant health information.
Administer immunizations, injections, medications, and point-of-care testing per provider orders and scope of practice.
Perform specimen collection, EKGs, hearing and vision screening, and other clinical support services as assigned.
Assist providers with examinations, procedures, and treatment plans.
Conduct medication reconciliation and review medication adherence.
Document patient encounters accurately and timely within the Electronic Health Record (EHR).
Monitor and communicate abnormal findings to providers promptly.
Participate in daily huddles and interdisciplinary care team meetings.
Provide patient education related to chronic disease management, preventive care, medications, nutrition, lifestyle modification, and treatment adherence.
Identify high-risk patients requiring enhanced care management services.
Coordinate referrals to specialists, diagnostic testing, community agencies, and social service organizations.
Track referral completion and follow up on outstanding appointments and results.
Conduct outreach to patients following emergency department visits, hospitalizations, and psychiatric admissions.
Assist patients in scheduling appointments and overcoming barriers to care.
Collaborate with behavioral health providers to develop integrated care plans.
Support transitions of care and ensure continuity between healthcare settings.
Monitor patients with chronic conditions such as diabetes, hypertension, obesity, COPD, asthma, hyperlipidemia, and other chronic diseases.
Assist in closing preventive care gaps including annual wellness visits, immunizations, cancer screenings, and chronic disease monitoring.
Coordinate social determinants of health interventions and connect patients with housing, food, transportation, financial assistance, and other community resources.
Maintain care management registries and patient tracking systems.
Participate in population health initiatives and quality improvement programs.