This role serves as a primary point of contact for a panel of members, maintaining consistent phone, text, and in-person outreach. You will build long-term, trust-based relationships to support engagement and continuity of care. Help members navigate healthcare and social service systems, including housing, food access, transportation, and behavioral health. Coordinate care activities, such as scheduling appointments, managing referrals, and ensuring timely follow-ups. Collaborate closely with nurses, behavioral health care managers, and other care team members to ensure high-quality, integrated support. Surface and help resolve barriers that may prevent members from accessing or continuing care. Accurately document all member interactions and coordination activities in internal systems. Meet outreach, documentation, and engagement targets in line with program requirements. Participate in field-based member visits as needed to support engagement and outreach efforts.