LPN (SNF)

Key Responsibilities

Patient Coordination & On-Site Support

● Manage a caseload of patients enrolled in the behavioral health program. Caseload will be determined based on CMS regulations and VBC programs.

● Perform monthly behavioral health screenings as required based on individual patient needs and PHA protocols.

● Identify and promptly escalate changes in condition, safety concerns, or other clinical updates to the BHCM or appropriate clinical team.

● Support coordination of additional behavioral health services when indicated.

Facility Collaboration

● Serve as the primary on-site behavioral health coordination contact for assigned facilities.

● Communicate with facility leadership, nursing staff, therapy teams, social services, and IDT members to support continuity of behavioral health care.

● Assist with scheduling, coordination, and on-site logistics to support psychiatric and psychology services.

Documentation & Compliance

● Complete required monthly documentation accurately and on time, according to PHA policies and workflows.

● Maintain patient information, screenings, coordination activities, and communication records within the EHR.

● Adhere to all documentation, privacy, compliance, and behavioral health workflow standards.

Internal Operations & Escalation

● Collaborate with the BHCM on care coordination needs, caseload updates, and workflow execution.

● Participate in routine check-ins, supervision, and team meetings as assigned.

● Follow escalation pathways for clinically significant changes, facility concerns, workflow barriers, or safety-related observations.

Travel & Field-Based Expectations

● Travel between assigned facilities within a regional territory on a rotating or cycling schedule.

● Maintain professional conduct and communication across all facilities and patient interactions.

Qualifications

Required

● Experience working in healthcare, behavioral health, care coordination, case management, or related patient-facing work.

● Ability to manage a high-volume caseload and navigate multiple facility environments.

● Proficiency with electronic health records (EHR) and digital communication tools.

● Strong communication, organization, critical thinking, and follow-through.

● Demonstrated cultural competency and ability to work effectively with diverse populations.

● Reliable transportation and ability to travel within a defined region.

Preferred

● Experience in post-acute, skilled nursing, assisted living, or other long-term care settings.

● Experience supporting behavioral health services (clinical or non-clinical).

● Bilingual (e.g., Spanish) preferred but not required.

Physical Demands, Equipment, and Work Environment

● Regular travel between facilities within the assigned regional territory.

● Ability to sit, stand, walk, and move within facility environments for extended periods.

● Occasional lifting up to 20 pounds (e.g., equipment, materials).

● Frequent use of laptop, tablet, smartphone, and digital tools for communication and documentation.

● Work performed on-site in post-acute, skilled nursing, or long-term care facilities with typical clinical and administrative conditions.