LPN/ LVN Care Coordinator for CCM in Abbeyville, Colorado at Comprehensive Rehab Consultants

The LPN/LVN Care Coordinator will be 100% remote and will be responsible for delivery of Chronic Care Management services, allowing patients to thrive and progress toward desired outcomes.

Responsibilities include post-discharge patient outreach, patient-centered care plans, and service coordination utilizing software tools that facilitate communication and exchange of information with patients, CRC providers, and other care team members.

• Competitive salary and bonus opportunities
• 100% remote position
• Generous PTO package and time-off on selected holidays
• Health and other insurance including: Medical, Vision, and Dental, Short Term Disability, Life Insurance, Critical Illness, Hospital Indemnity
• 401(k) plan with an annual contribution of 2-3%

• Clinical Assessment & Planning: Review EMR records to conduct comprehensive physical and psychosocial risk assessments, identifying patient barriers and customizing care plans.
• Care Transition & Monitoring: Track ED visits and acute stays, performing post-discharge follow-ups and continuous readmission risk assessments.
• Patient Engagement & Education: Utilize motivational interviewing to empower self-management; provide chronic disease education and symptom management teaching to patients and caregivers.
• Care Coordination: Partner proactively with providers, patients, and caregivers to communicate assessment findings, care goals, and changes in status, securing necessary orders or referrals.
• Documentation & Compliance: Maintain precise, timely logging of care plans, interventions, and patient outreach within the care management software system.
• Collaboration: Build and maintain strong, professional working relationships with assigned providers and the broader care management team.

• Active LPN/LVN or equivalent license
• 2+ years of clinical experience with the geriatric population in the post-acute space (SNF/HH)
• 1+ years of 100% remote telephonic experience that includes direct patient interaction

• Associates or Bachelors level education
• Knowledge and experience with a variety of electronic medical records (EMR) and Care Management technology
• An understanding of CMS compliance regulations