Are you passionate about helping people live healthier, longer lives? TAN Healthcare is seeking a dedicated Chronic Disease Care Manager or LVN to lead our One Year to a Healthier You (OYHY) program—a community-focused initiative aimed at preventing and managing chronic conditions such as diabetes, hypertension, and obesity. In this role, you’ll blend clinical expertise, health education, and community engagement to empower patients to make lasting lifestyle changes.

What You’ll Do:

Patient Engagement & Care Coordination

• Serve as the primary point of contact for referred patients.
• Conduct comprehensive intake assessments, including social determinants of health.
• Develop personalized care plans focused on lifestyle modification.
• Coordinate care across TAN departments and with external partners to ensure seamless support.

Program Delivery & Education

• Lead engaging individual and group health education sessions covering nutrition, physical activity, portion control, sodium reduction, and cancer prevention.
• Track patient progress, including biometric data and session participation.
• Provide ongoing follow-up, motivation, and accountability to program participants.
• Guide patients in using Remote Patient Monitoring (RPM) tools to stay on track.

Community Collaboration & Outreach

• Partner with organizations like Market to Hope for food distribution, community screenings, and educational initiatives.
• Support training of staff and volunteers to expand program impact.
• Participate in community outreach events and help promote the OYHY program.

Documentation & Reporting

• Maintain accurate and timely records in the Electronic Health Record (EHR).
• Submit monthly reports tracking patient engagement and program outcomes.
• Assist with grant compliance, outcome tracking, and quality improvement initiatives.

What We’re Looking For:

• LVN applicants: Current, unrestricted Texas LVN license and degree from an accredited nursing school.
• Care Manager applicants: Relevant experience in care coordination or chronic disease management.
• Strong understanding of social determinants of health and health disparities.
• Experience facilitating group education or wellness classes.
• Excellent interpersonal, organizational, and communication skills.
• Comfortable with Microsoft Office and EHR documentation.

Preferred:

• Bilingual (Spanish/English) highly preferred.
• Familiarity with Southeast Texas community resources and population health needs.

Work Environment:

• Hybrid office and field-based role.
• Local travel to community events, food pantry locations, and TAN Healthcare sites required.
• Must be able to sit, stand, and walk for extended periods.

Why TAN Healthcare?
You’ll be part of a team that truly cares about making a difference in the community, empowering patients to achieve meaningful health outcomes, and fostering a collaborative, supportive work environment. If you’re ready to combine your clinical skills, passion for education, and commitment to community health, this is the role for you.