Registered Nurse (RN) or Licensed Practical Nurse (LPN): Rural Health Transformation Program

Job Description:

Registered Nurse (RN) or Licensed Practical Nurse (LPN): Rural Health Transformation Program

Southern Jersey Family Medical Centers, Inc. is looking for a talented Licensed Practical Nurse (LPN) with the highest level of professionalism to step into our fast-paced facility!

Summary: 

The Rural Health Licensed/Registered Nurse supports implementation of Activity A and Activity B under the rural health grant by delivering and coordinating nursing services that improve access, continuity of care, and chronic disease management for residents in rural and medically underserved communities.

This position supports the organization’s mission as a Federally Qualified Health Center (FQHC) by providing patient-centered care across clinic, community, mobile, and home-based settings, including the Mobile Medical Unit, Remote Patient Monitoring (RPM), and follow-up home visits. The role focuses on improving health outcomes, reducing barriers to care, and ensuring alignment with HRSA Health Center Program requirements, clinical quality standards, and organizational policies.

Hours: This position requires the ability to work a flexible schedule. General daytime hours Monday - Friday with some weekends.

Position Responsibilities/Duties:

• Clinical Care & Program Implementation

  • Provide nursing support for Activity A and Activity B in alignment with grant objectives, clinical workflows, and organizational policies
  • Deliver patient-centered nursing care through Mobile Medical Unit outreach, RPM, and follow-up home visits, as applicable
  • Conduct clinical assessments, screenings, and nursing interventions within scope of licensure in clinic, mobile, and community settings
  • Perform follow-up home visits for patients requiring chronic disease monitoring, medication review, care plan reinforcement, or post-discharge support
  • Assess patient status, including symptoms, vital signs, adherence, safety risks, and barriers to care, and escalate concerns appropriately
  • Monitor RPM data, identify trends, and coordinate timely clinical follow-up

  Care Coordination & Patient Education

  • Educate patients and caregivers on disease management, medications, RPM device use, warning signs, and when to seek care
  • Reinforce provider care plans, discharge instructions, and follow-up requirements
  • Coordinate with providers and interdisciplinary care team members to ensure continuity of care
  • Support transitions of care through outreach, reassessment, and linkage to primary and specialty services
  • Assist patients with telehealth access and basic technology navigation

  Access, Equity & Community Engagement

  • Deliver culturally competent, patient-centered care to diverse and underserved populations
  • Identify and address social determinants of health, including transportation, housing, food insecurity, and access barriers
  • Support patient access initiatives, including sliding fee discount program processes, as applicable

  Documentation, Compliance & Quality

  • Maintain accurate, timely, and compliant documentation in the electronic health record in accordance with organizational, state, federal, and HRSA requirements
  • Participate in care team huddles, case reviews, and quality improvement initiatives
  • Support data collection and reporting related to clinical outcomes and Uniform Data System (UDS) measures, as applicable
  • Ensure compliance with nursing standards, infection control practices, and HIPAA requirements
  • Maintain records in accordance with Department of Health guidelines

  Operational Responsibilities

  • Perform immunizations and injections within scope of licensure
  • Communicate effectively with patients via in-person, telephone, and electronic methods
  • Maintain medical supplies, medications, and equipment in accordance with safety standards
  • Ensure proper use of personal protective equipment (PPE)
  • Collaborate across departments to support patient care delivery
  • Safeguard organizational records in accordance with regulatory requirements
  • Perform other duties as assigned