Perform monthly clinical check-ins and structured symptom assessments for assigned patient panels.
Collaborate with providers to escalate urgent issues and reinforce care plans within LPN scope.
Document all patient interactions in EHR and CCM platform while ensuring compliance with billing and quality metrics.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic approach. The company is committed to improving patient outcomes and quality of life, but specific employee size is not mentioned.
Consult directly with patients and care teams to implement comprehensive pharmacy care management programs.
Optimize medication therapy regimens using principles of Comprehensive Medication Management (CMM).
Drive medication-related clinical quality initiatives, including GDMT optimization and adherence improvement.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic approach. The company provides interdisciplinary clinical resources and analytical tools to improve patient outcomes, and fosters a culture of innovation and compassion.
Serve as a vital link between patients and healthcare services, coordinating care across primary, specialty, and behavioral health divisions.
Conduct patient assessments and community outreach to engage underserved populations in the Bronx, addressing barriers to care.
Utilize remote patient monitoring tools and electronic health records to track patient progress and adjust care plans.
Essen Health Care is the largest privately held, multispecialty medical group in New York, providing high-quality, compassionate care to underserved residents. Founded in 1999, the company has grown to 50+ locations with 500+ providers, focusing on a population health model and a supportive team environment.
Conduct Chronic Care Management follow-up calls and build positive patient relationships.
Accurately document patient interactions and maintain tracking logs using Google Drive and Sheets.
Coordinate care activities, monitor patient progress, and ensure HIPAA compliance.
SnappyCX provides healthcare staffing and management solutions, specializing in chronic care management and remote patient support. The company is a growing organization that values bilingual, self-motivated professionals in a fully remote, collaborative environment.
Conduct high-volume outbound calls to engage patients and schedule healthcare services, including mammograms and bone density screenings.
Identify and address social determinants of health barriers by connecting patients to community resources.
Build trust with patients through clear, empathetic communication and ensure completion of care.
Sprinter Health is building the clinical and technological infrastructure to expand access to healthcare through home-based services. We have a rapidly growing team of visionary leaders backed by prominent VCs and advised by industry leaders.
Coordinate care for adolescent and young adult patients, including outreach, chart scrubbing, and panel management.
Provide medical assistant duties and support the care team with referrals, follow-ups, and documentation.
Communicate with patients and families via phone, MyChart, and email to ensure compliance and care coordination.
Oregon Health & Science University is a public academic health center in Portland, Oregon, providing patient care, groundbreaking research, and training for healthcare professionals. It is the largest employer in Portland, operating hospitals and clinics across Oregon and Southwest Washington, and is committed to being an anti-racist, multicultural institution.
Build trusting relationships with patients and providers to address health barriers and coordinate care.
Navigate medical, behavioral, and social systems to connect patients with appropriate resources.
Support value-based care outcomes through proactive outreach, documentation, and quality measures.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. As a growing and innovative organization, we operate with a high degree of agility.
Serve as the first point of contact for members, triaging communication and coordinating with Maternity Navigators.
Schedule and confirm visits, verify insurance, and maintain real-time visibility into care team schedules.
Build ongoing relationships with members through proactive outreach and help them access non-clinical supports like transportation and WIC.
Nadia Care is reimagining maternity care to improve pregnancy, birth, and postpartum outcomes for underserved communities, with a focus on Black, Brown, and Indigenous families. They are a small startup building trust-based engagement and wrap-around support for expectant mothers.
Educates patients about eligible healthcare services and directly schedules them with the provider team.
Builds trust-based relationships by empathetically addressing patient inquiries and objections.
Makes outbound calls to educate patients on Strive's holistic care model and schedules provider visits.
Strive Health is on a mission to transform chronic conditions by identifying risk earlier, coordinating thoughtful care, and supporting people through every stage of their health journey. The company is a passionate team that cares deeply about making an impact, shows up as One Team, and elevates the everyday.
Serve as a community-based, patient-facing resource, building relationships with patients and caregivers through direct, in-person re-engagement in assigned geographic areas.
Provide hands-on support to patients and caregivers, including assisting with program re-enrollment, onboarding, and mobile app setup.
Educate patients and caregivers on Imagine Pediatrics services and available community resources to ensure they understand how to access care and support.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group that provides 24/7 virtual-first and in-home care for children with special health care needs. The company emphasizes compassion, creativity, and a commitment to children with medical complexity, though specific employee count is not provided.
You are responsible for supporting care delivery by partnering with Advanced Practice Providers to execute individualized care plans for patients with chronic kidney disease, hypertension, diabetes, and congestive heart failure.
This role focuses on enhancing clinical outcomes, patient engagement, and care coordination through education, remote monitoring, medication management, and longitudinal patient support.
Key responsibilities include visit preparation, care plan execution, disease management education, medication management, quality measure support, and cross-functional collaboration.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered approach. They are a growing company building a healthcare delivery model focused on improving patient outcomes and quality of life, with a robust team and culture that emphasizes innovation and support.
Serve as the primary point of contact for patients after their intake visit, guiding them through their care plan.
Help patients schedule appointments, find in-network providers, and navigate Medicare benefits.
Document all patient interactions accurately and maintain confidentiality.
Mira Mace is a venture-backed company that helps Medicare patients navigate healthcare with clarity and confidence. They deliver Community Health Integration and Principal Illness Navigation services through affiliated provider organizations, with a small, patient-focused team.
Collaborate with primary care providers to coordinate care for patients with multiple chronic conditions, ensuring high-quality care through telephonic and in-person outreach.
Conduct transitional care management including post-discharge follow-up and provide education on lifestyle coaching and dietary improvements.
Operate independently to achieve goals, attend regular care team meetings, and perform other duties as assigned.
Privia Health is a technology-driven national physician enablement company that collaborates with medical groups and health systems to optimize practices and improve patient care. The company is led by top industry talent and focuses on scalable operations and cloud-based technology to reduce healthcare costs and improve outcomes.
Conduct high-volume telephonic and text outreach to eligible families to schedule initial visits with the clinical team.
Use CRM tools to manage eligibility lists and meet daily, weekly, and monthly targets for sign-ups.
Develop and refine outreach strategies and messaging to improve activation rates.
Nest Health is a value-based care provider offering comprehensive medical, behavioral, and social care to families through an in-home and virtual model. As a fast-growing startup founded in 2022, Nest fosters a collaborative, entrepreneurial culture where team members wear multiple hats and drive impact.
Conduct telephonic outreach to Medicare members to improve medication adherence and HEDIS diabetes and blood pressure control.
Use motivational interviewing to assess health risks and engage members in behavior change.
Partner with members to identify opportunities for integration into internal/external programs and coordinate care.
CVS Health is building a world of health around every individual, shaping a more connected, convenient and compassionate health experience. They are a large company with passionate colleagues who care deeply, innovate with purpose, and prioritize safety and quality.
Answer inbound calls and make outbound calls to participants enrolled in the Condition Management Program.
Assist participants via email and online messaging, and accurately document all participant communications.
Work independently and in a team environment with strong customer service skills; no experience required as training is provided.
Cottingham and Butler's Health and Wellness division focuses on reducing medical costs while increasing employee engagement and productivity through onsite screenings, technology, and condition management programs. They value an open-door culture where team opinions are appreciated.
Complete biopsychosocial assessments to identify clinical, behavioral, and social needs.
Proactively identify and resolve care gaps in patient records, ensuring timely clinician review.
Coordinate referrals, follow-up appointments, and community-based care support services.
Knownwell provides weight-inclusive healthcare for all, offering weight management, primary care, nutrition counseling, and health coaching. They are backed by $50M in funding, scaling fast to expand access to evidence-based obesity care nationwide.
Guide patients through the healthcare system by translating medical complexity into plain language and coordinating care.
Build and own care plans that address both medical needs and social determinants like transportation and food access.
Solve real problems with persistence by navigating denied claims, missed referrals, and unaffordable medications.
Careway Health is building an advocacy-first telehealth platform to help seniors overcome complex health and social challenges and maximize independence. They are a growing company focused on democratizing access to high-quality care with a team of physicians and health advocates.
Provide exceptional care, disease management and health education to patients.
Support goal setting for individual patients to help them better manage chronic conditions.
Coordinate with other clinical team members to provide an exceptional patient experience.
Salvo Health is a tech-enabled healthcare company focused on chronic gut and metabolic conditions. Backed by leading health investors, it offers a multidisciplinary care team approach with board-certified specialists and digital tools.