​Licensed Vocational Nurse

Habitat Health empowers older adults to experience more good days in their homes and communities. Through the Program of All-Inclusive Care for the Elderly (PACE), we provide comprehensive medical care along with support for daily needs such as meals, transportation, and in ‑ home assistance. We deliver coordinated clinical and social care in our centers and directly in participants’ homes, creating a fully integrated experience that brings peace of mind and a true sense of belonging. As we expand our scalable, affordable PACE model to meet the growing and complex needs of aging populations, our mission ‑ driven care teams continue to help participants live well on their own terms.   Habitat Health is supported by leading healthcare organizations and investors including New Enterprise Associates, Kaiser Permanente, and Town Hall Ventures. We are entering a period of significant growth and are looking for exceptional teammates to help us scale a better model of care for older adults. To learn more, visit www.habitathealth.com. Role Scope :  We are looking for a Home Care Coordinator to ensure that personal and clinical home care needs are delivered to help our participants thrive. As a member of the Interdisciplinary Team (IDT), the Home Care Coordinator participates in the assessment of participant needs, development of care plans, and coordination of home care services to support safe, effective, and person-centered care in the home setting.     Core Responsibilities & Expectations for the Role   Exhibit and honor Habitat’s values.   Conduct comprehensive in-home assessments to evaluate participant care needs, functional status, safety risks, and appropriateness of home care services    Perform home safety evaluations and provide recommendations to promote participant independence and reduce risk    Assess participants' ability to safely perform tasks and utilize adaptive equipment through observation and return demonstrations    Collaborate with participants, caregivers, and family members to identify care needs and service gaps    Participate as an active member of the Interdisciplinary Team (IDT) in developing, implementing, and updating participant care plans    Partner with clinical and non-clinical team members, including rehabilitation, nutrition, and social services staff, to ensure a comprehensive understanding of participant needs    Coordinate home care services to align with the participant's individualized care plan and goals  Evaluate completed caregiver tasks and identify services that are frequently declined, missed, or not completed as planned     Review weekly home care notes and documentation to identify service gaps, changes in participant condition, Service Determination Requests (SDRs), grievances, and other concerns requiring follow-up or escalation to the appropriate team members.     Maintain current and accurate authorizations for home care services, ensuring services are aligned with participant needs and payer requirements    Monitor authorization status and coordinate renewals to prevent interruptions in service    Maintain timely, accurate, and compliant documentation in electronic health records and operational systems    Support quality improvement initiatives and compliance activities related to home care services    Perform other related duties as assigned   Required Qualifications:    Minimum of two (2) years of clinical experience, preferably in home care, geriatrics, care coordination, primary care, or a related healthcare setting   Knowledge of care planning, clinical assessments, and home care service delivery    Ability to conduct comprehensive participant assessments and identify changes in condition or care needs    Strong clinical judgment and critical thinking skills    Excellent interpersonal, communication, and collaboration skills    Ability to work effectively within an interdisciplinary team environment    Strong organizational skills with the ability to manage multiple priorities and deadlines    Proficiency with electronic health records and healthcare documentation systems    Valid driver's license, reliable transportation, and active auto insurance in accordance with state requirements   Demonstrates ability to use motivational interviewing, trust building techniques, and clear expectation setting to support acceptance of clinically appropriate home care hours and care recommendations.    Preferred Qualifications:   Active Licensed Vocational Nurse (LVN) license in the applicable state   Experience working with older adult populations    Experience in PACE, home health, home care, or managed care environments   Bilingual: Spanish/Mandarin/Cantonese preferred.   Experience with care coordination, utilization management, or authorization processes  preferred   Essential Functions & Physical Requirements   The following statements describe the general nature of work and physical expectations common across roles at Habitat Health. Specific responsibilities may vary by position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.   Team members in this role may be expected to:   Work in healthcare, administrative, community, or remote environments, depending on role needs.   Communicate effectively with participants, caregivers, team members, and other stakeholders in person, by phone, and through electronic systems.   Remain stationary and/or move about for extended periods, consistent with job duties.   Operate standard office equipment and/or clinical tools (e.g., computers, phones, medical devices, documentation systems).   Travel between work sites or community locations as needed.   Follow safety procedures, infection control protocols, and use personal protective equipment (PPE) when required.   Perform tasks that may involve bending, reaching