LVN Care Coordinator - APCP, Part time (23558)

Cantex Continuing Care Network•Houston, TX

40d•Onsite

About The Position

The LVN Care Coordinator (LVNCC) partners with the ProCare Advantage Institutional Special Needs Plan (ISNP) Nurse Practitioner (Plan NP) to coordinate care for ISNP Beneficiaries (Plan Members). The LVNCC maintains routine contact with Plan Members, families, and facility staff, monitors changes in condition, and ensures timely communication with Plan NPs and interdisciplinary care teams. This role plays a critical part in supporting proactive care management, reducing unnecessary transitions, and improving outcomes for high-acuity long-term care residents.

Requirements

Active Licensed Vocational Nurse (LVN) license in the respective state
Compliance with all required State and Federal guidelines
Must maintain ongoing Texas Board of Nursing educational requirements for licensure and re-certification
Strong communication and coordination skills
Ability to work collaboratively with interdisciplinary teams and facility leadership
Ability to communicate in English via phone, in writing, and verbally with staff, residents, families, and external partners
Ability to stand, walk, sit, reach, handle, or feel objects as needed
Ability to drive a personal vehicle to multiple facility locations
Ability to lift up to 50 pounds occasionally
Ability to use a computer, phone, and related technology for extended periods

Responsibilities

Assist the Plan NP with care coordination duties and documentation for Plan Members
Initiate and complete assessments, including vital signs and other clinical data collection
Perform daily rounds to identify medical, emotional, or behavioral changes in Plan Members
Obtain daily Plan Member census and report transitions (ED visits, hospitalizations, hospice elections, returns from hospital) to Plan NPs and RNPs
Monitor Plan Members during transitions to and from the hospital; communicate updates to facility staff and Plan NPs
Ensure Plan NP receives all discharge paperwork and summaries following hospital transitions
Conduct timely in-person follow-ups after transitions to reduce readmission risk and identify additional needs
Partner with facility staff and the Interdisciplinary Care Team (ICT) to implement care plans and coordinate specialty, therapy, or ancillary services
Alert the Plan NP promptly of new enrollees and prioritize intervention for Plan Members at risk for transition
Support proactive care management to improve outcomes and reduce unnecessary hospitalizations
Must practice under the direction of the Plan NP and within LVN scope as defined by the Texas Board of Nursing
Perform other duties as assigned
Attend required in-services and continuing education programs to maintain professional licensure and certification
Participate in ongoing education related to Medicare and Managed Care Case Management