Chronic Care LVN (Hybrid)

COMPANY OVERVIEW

At Harbor Health, we’re transforming healthcare in Austin through collaboration and innovation. We’re seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model.
If you’re ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!

POSITION OVERVIEW

Harbor Health is seeking a dedicated Chronic Care LVN to play a key role in supporting members with chronic diseases. The LVN will serve as a central connection between members and care teams, leveraging Remote Patient Monitoring (RPM) tools and driving programmatic support to improve outcomes. This position is vital to ensuring members are empowered, supported, and guided through their chronic care pathways.

POSITION DUTIES & RESPONSIBILITIES:

• Provide direct support to members with chronic diseases, ensuring continuity of care across chronic care pathways.
• Communicate regularly with members to assess progress, resolve barriers to care, and promote adherence to treatment plans.
• Assist with the implementation, education, and ongoing use of Remote Patient Monitoring (RPM) equipment to track vital health data.
• Monitor data from RPM systems to identify trends and escalate concerns to the care team.
• Collaborate with Clinicians, Nurse Practitioners, and Specialists to ensure appropriate follow-up and timely interventions.
• Drive programmatic support and improvements by contributing to workflows, care protocols, and innovative approaches to chronic care management.
• Document all interactions and interventions thoroughly and accurately in the Electronic Health Record (EHR) system.
• Educate members and caregivers on chronic disease management strategies, emphasizing self-care and prevention.
• Support quality initiatives and program changes to enhance member outcomes and satisfaction.
• Assist with triaging calls, managing routine clinical tasks, and coordinating care activities.
• Foster a collaborative, member-centered environment that prioritizes safety, dignity, and respect.

DESIRED PROFESSIONAL SKILLS & EXPERIENCE:

• Current LVN license required
• Minimum 2 years of nursing experience, preferably in chronic disease management, primary care, or care coordination.
• Experience with Remote Patient Monitoring (RPM)