Licensed Practical Nurse/Medical Home Coordinator

LPN provides direct and indirect patient care in a primary care office and works with care delivery providers to identify gaps in care, contacts patients to schedule required care, and provides referral follow up. The Medical Home LPN provides pre-visit planning for the practice's patient panel, coordinates messages through electronic portals, and assists in managing transitions of care. The LPN acts as a clinical liaison to the physician care plan and communicates with patients, participates in process improvements, and supports wellness and prevention. Responsibilities include coordinating primary care rooming and procedures (immunizations, venipuncture, point-of-care testing, retinal imaging), documenting care and patient communications (MyChart and portal messages), reviewing charts for gaps in care, supporting outreach, promoting wellness, educating patients on chronic disease management, and facilitating follow-up appointments and referrals, while collaborating with RNs, Social Workers, CHWs, and pharmacists.