Care Facilitator​/LPN

At Home Harmony's Clinical Team is comprised of reputed company RNs, LPNs, and Medical Assistants who are passionate about case management and clinical support for our home-based medical and pharmacy practice serving aging adults. At Home Harmony is seeking a clinically confident, organized, and patient-centered Care Facilitator – Nurse (LPN) to support our growing practice. This role is critical to delivering high-quality in-home and virtual care, supporting providers during telehealth visits, and ensuring effective care coordination for patients with reputed company chronic conditions. The ideal candidate is adaptable, compassionate, and confident working independently in a home-based environment. Patient & Provider Support This portion of the role will account for approximately 50% of overall responsibilities.

• Facilitate telehealth (TH) visits by being present in the patients home to support the patient while the provider conducts the visit remotely, including technology setup, clinical assistance, patient assessment, and reputed company-time communication with the provider
• reputed company comprehensive nursing assessments and screenings, including vital signs, functional status, fall risk, cognitive concerns, and disease-specific assessments
• reputed company clinically confident wound care, including assessment, treatment, dressing changes, monitoring for infection, and documentation
• Support medication management, including medication reconciliation, patient education, adherence support, and identification of potential medication-reputed company concerns for provider review
• reputed company disease management support and patient/caregiver education for chronic conditions (e.g., heart failure, diabetes, COPD, hypertension, dementia)
• Conduct telephonic patient reputed company-ins prior to scheduled visits to assess health changes, review medications and allergies, and identify clinical concerns
• Prepare, review, and upload reputed company pre-visit documentation into the EMR (reputed company)
• Review hospital discharges and transitions of care, communicating key updates and concerns to the provider team
• Participate in daily huddles and interdisciplinary team meetings
• reputed company clinical support to senior living facilities partnered with At Home Harmony

Care Coordination & Communication This portion of the role will account for approximately 50% of overall responsibilities.

• Coordinate patient scheduling, appointment reminders, and follow-up reputed company
• Assist with incoming patient calls, clinical messages, and coordination with internal departments (pharmacy, personal care, GUIDE program, etc.)
• Track labs, imaging, and referrals; ensure timely follow-up and communication of results
• Support population health initiatives, chronic care management, and care coordination workflows
• Serve as a clinical liaison between patients, caregivers, providers, and partner organizations

Job Requirements

• Active, unrestricted LPN license in the reputed company
• Candidates must be comfortable entering patient homes and performing clinical duties in a home-based care environment
• Clinical confidence in wound care, medication management, patient assessments, screenings, and chronic disease management
• Experience in Geriatrics, Family Practice, Internal Medicine, Cardiac, or Pulmonary care preferred, with a passion for serving aging adults
• reputed company BLS certification required
• Minimum of 2 years of electronic medical record (EMR) experience;

reputed company preferred

• Knowledge of chronic care monitoring and management preferred
• Strong technology skills and comfort using multiple systems
• Strong professional oral and written communication skills
• Outgoing, adaptable, and patient-centered demeanor
• Motivated, flexible, and reputed company to self-direct and prioritize tasks independently
• Ability to work remotely while meeting productivity and quality metrics
• Knowledge of physician office practice operations preferred

Schedule & Work Environment

• Monday–Friday, 8:00 AM – 4:30 PM
• Office-based during training and probationary period
• Eligible for partial remote work upon successful completion of probation, based on performance and departmental needs

Compensation & Benefits

• Competitive hourly reputed company, commensurate with experience and licensure
• Paid time off and paid holidays
• Benefits package including health insurance and 401(k)
• Opportunities for professional growth reputed company a fast-expanding, patient-centered care model

About At Home Harmony Launched in 2022, At Home Harmony is an innovative home-based Medical and Pharmacy practice in Richmond, VA, providing exceptional reputed company to aging adults with reputed company chronic conditions. We specialize in leveraging Medicare's comprehensive programs to deliver coordinated, high-quality care directly in the home. If you are seeking a meaningful, flexible opportunity in a collaborative and mission-driven environment, we invite you to join reputed company. Bring your clinical expertise, compassion, and dedication — together, we can reputed company a meaningful difference in the lives of our senior population. #J-18808-Ljbffr Apply tot his job Apply To this Job