Care Coordinator-LPN- Home Care Services

Roanoke, VA, US, 24016

Employment Status:  Full time
Shift:  Day
Facility:  Carilion Clinic Home Care
Requisition Number:  124518

Job Summary

Provides care management for specific patient populations, utilizing clinical expertise, communication and problem solving skills to achieve optimal clinical and resource outcomes. Promotes cost-effective care by minimizing fragmentation, maximizing coordination and facilitating patient/family movement through the system.  Applies protocols when appropriate and facilitates referrals, providing linkages to health and wellness resources across the health care continuum. Promotes interdisciplinary collaboration and teamwork to progress the plan of care. Must possess knowledge of growth and development appropriate to age group served and incorporate plan to meet needs into plan of care. 

  • Coordinates care and services within care managed population. 
  • Performs patient/family data collection to assist in identifying individualized care management needs. 
  • Using evidence based protocols, implements plan of care interventions as identified by the Care Team and communicates with clerical and clinical support staff to coordinate activities to meet care needs.
  • Works with Care Team to identify individual care management needs. Huddles daily with Care Team for pre/post-visit planning to identify those patients who need close follow up, resources, additional education, and support. 
  • Documents needed interventions on provider’s schedule ie  necessary labs, patients in poor control or who may need intensive education in-house or through referral.
  • Coordinates plan of care and services, directing liaison activities to appropriately integrate the patient into the health care continuum. 
  • Monitors plans of care/pathways/practice guidelines to ensure that expected patient outcomes are achieved within appropriate time frames and utilizing effective resources.
  • Facilitates Interdisciplinary Team Meetings. Provides feedback to the health care team verbally or via chart entries related to the patient’s progress toward reaching expected outcomes or about barriers to the plan. Coordinates changes to the plan as necessary.
  • Documentation in the medical record is completed in the appropriate time frame and accurately reflects the plan of care and care management interventions planned or completed. Facilitates physician documentation of data that accurately reflects the patient’s condition, co-morbidities, treatment and procedures that support the most appropriate status.

Minimum Qualifications

Education: Graduate of an accredited school of practical nursing.

Experience: Five years recent experience in a physician practice or clinic.

Licensure, certification, and/or registration: Current license to practice practical nursing (LPN) in the state of Virginia. AHA BLS-HCP required in practices where the Care Coordinator provides direct patient care. Case Management or Care Coordination Certification required within one year of hire.

Other Minimum Qualifications:  Must demonstrate knowledge and competency in the following areas: positive interpersonal oral communication skills; effective written communication skills; analytic skills; team player; courteous; ability to resolve complaints/problems; customer-focused philosophy of service delivery; ability; willingness to work as an integral member of a multi-skilled team. Also demonstrate knowledge and competency in: computer literacy; community and system resources; effective interpersonal relations; analysis and research methods.

About Carilion

This is Carilion Clinic ...

An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.

Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.

Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.


Requisition Number: 124518 
Employment Status: Full time 
Location: Carilion Clinic Home Care 
Shift: Day 
Shift Details: M-F 9 to 6 with rotating weekends and holidays --remote work avaiable
Recruiter Email:
For more information, contact the HR Service Center at 1-800-599-2537.

Equal Opportunity Employer

Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity

Carilion Clinic is a drug-free workplace.


Carilion Total Rewards

What matters to you is important to us—like benefits, rewards, and resources to improve your life. Carilion understands the importance of prioritizing your well-being to help you develop and thrive. When you make your tomorrow with us, we’ll enhance your potential to realize the best in yourself. Below are benefits available to you when you join Carilion:

  • Employer Funded Pension Plan, vested after five years (Voluntary 403B)
  • Comprehensive Medical, Dental, & Vision Benefits
  • Flexible Work Arrangements/Schedules
  • Remote Work Options
  • Paid Time Off (accrued from day one)
  • Onsite fitness studios and discounts to our Carilion Wellness centers
  • Access to our health and wellness app, Virgin Pulse
  • Discounts on childcare
  • Continued education and training

Find more about Carilion Clinic’s benefits by vising our Total Rewards Page.

Equal Opportunity Employer
Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity
Carilion Clinic is a drug-free workplace.

Nearest Major Market: Roanoke

Job Segment: Home Care, Patient Care, Nursing, Clerical, NICU, Healthcare, Administrative