Care Management Coach - Cardiac Rehab

Patient Management:

• Conduct telephonic and virtual care management for patients with heart failure.
• Review and assess patients' medical, functional, and psychosocial needs remotely.
• Reinforce heart failure self-management education.

Care Coordination:

• Collaborate with providers, specialists, and care teams to optimize patient care.
• Schedule and manage follow-up appointments.
• Assist in supporting care transitions and reducing hospital readmissions.

Patient Engagement:

• Educate patients and families about heart failure management and available resources.
• Support patients in self-management and behavior modification interventions.
• Conduct motivational interviewing to encourage lifestyle changes.

Documentation and Compliance:

• Maintain accurate and timely documentation in electronic health records (EHR).
• Ensure services are provided in accordance with Care Management program requirements.
• Adhere to applicable confidentiality, privacy, and data security requirements.