Act as the primary point of contact and care advocate for patients, families, facility partners, and providers.
Proactively manage patient care coordination, including appointment scheduling, follow-up care, and interdisciplinary communication.
Maintain comprehensive and accurate patient documentation within our Electronic Medical Record system.
Pine Park Health is a value-based primary care practice redesigning how residents of senior living communities get or stay healthy. They aim to dramatically improve healthcare for seniors by building a new model of care designed around everyone involved.
Serve as primary contact for patients, families, and providers
Schedule and coordinate medical appointments
Manage patient documentation and EMR updates
Pine Park Health is a value-based primary care practice redesigning how residents of senior living communities get or stay healthy and lead a life they love. They've expanded to over 185 communities across Arizona, California, and Nevada with investments from firms like First Round Capital and Google’s AI fund.
Serve as primary contact for patients, families, and providers
Schedule and coordinate medical appointments
Manage patient documentation and EMR updates
Pine Park Health is a value-based primary care practice redesigning how residents of senior living communities get or stay healthy. They aim to dramatically improve healthcare for seniors with a new model designed around patients, families, community staff, providers, and payers.
Conduct research to understand healthcare needs and identify ways to reach caregivers.
Perform telephonic outreach to enroll children in care and ensure onboarding.
Collaborate with healthcare professionals to support patient re-engagement.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care, working alongside families, providers, and health plans.
Take inbound calls from patients, providers and members
Support members with their insurance needs, questions or concerns
Provide 24/7 Triage Support and assign priority for a Registered Nurse to provide health advice
Carenet Health pioneers advancements in healthcare consumer experience, interacting with 1 in 3 Americans daily. They integrate human touch with data-driven technology to improve healthcare, offering best-in-class clinical expertise and personalized solutions.
Serves as a primary point of contact for members, caregivers, and providers regarding nurse appointments and care coordination activities.
Coordinates and schedules nurse case management activities, including assessments, follow-ups, and interdisciplinary care team meetings.
Supports accurate documentation by ensuring required scheduling and encounter-related data is entered into designated systems.
Fallon Health is dedicated to providing equitable, high-quality, coordinated care to its members and is consistently recognized as a top health plan for member experience, service, and clinical quality. With roots dating back to 1977 in Worcester, Massachusetts, they focus on government-sponsored health insurance programs and value diversity and inclusion.
Conduct a live outreach call to newly enrolled patient in advance of their initiating clinical appointment
Manage follow-up outreach to schedule the Initial Care Navigation appointment
Escalate any clinical question, symptom, or safety concern immediately to the appropriate clinical contact
Carewell is dedicated to providing trusted caregiving solutions and support for individuals and families. They extend their commitment beyond products to person-centered navigation, care coordination, and advocacy services. They are a category-defining business and one of the fastest-growing companies in the US.
Perform monthly CCM touchpoints for assigned patient panels.
Evaluate changes in condition using licensed clinical judgment.
Escalate urgent issues based on defined triage pathways.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. They are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants.
Support proactive care coordination services for patients with complex chronic conditions.
Conduct patient outreach, maintain care plans, and support documentation compliance.
Coordinate communication between patients, providers, and healthcare partners.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach. They are committed to improving patient outcomes and improving quality of life.
Oversees the operations of the Care Coordination Team.
Manages daily operational workflows of Care Coordination teams to ensure practice readiness and service level performance.
Serves as the point of contact for operational escalations related to scheduling, access, onboarding and service recovery.
Teladoc Health is leading the next evolution of virtual care. They offer a high-performance culture where colleagues embrace challenges, drive transformative solutions, and create opportunities for growth.
Conduct targeted patient outreach to close care gaps and ensure timely care transitions.
Deliver high-touch engagement for high-risk patients to prevent readmissions through follow-up.
Collaborate with Practices to support interventions such as Transitional Care Management.
Aledade empowers independent primary care practices, helping them deliver better care and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Conduct timely post-discharge follow-up calls with patients after inpatient visits to assess needs and reinforce the plan of care.
Review and reconcile discharge medications and escalate any concerns to the Primary Care Provider.
Assist in coordinating and/or scheduling follow-up appointments with the patient's Primary Care Provider and/or specialists
Privia Health is a technology-driven physician enablement company that collaborates with medical groups, health plans, and systems. They optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care. The company is led by top industry talent and exceptional physician leadership.
Regularly engage with patients and track their adherence to their care plans.
Closely monitor your patients' device readings and dig into any out-of-bound values.
Maintain meticulous records of patient interactions, and program details.
Medsien is a leading provider of scalable remote care management, enabling healthcare practices to enhance patient engagement, improve outcomes, and optimize operational efficiency. Hundreds of organizations trust Medsien’s unparalleled technology solutions to implement exceptional remote care management programs, personalize every interaction, and improve the lives of those who need it most.
Help scale and execute a community-oriented primary care model.
Lead the team responsible for eligibility list outreach, inbound patient call support, and scheduling operations.
Oversee daily operations, performance metrics, quality assurance, and workflow optimization.
Zócalo Health is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the one-size-fits-all healthcare system. Founded in 2021, Zócalo Health is backed by leading healthcare and mission-aligned investors and is scaling rapidly across states and populations.
Conduct Annual Wellness Visit questionnaires over the phone with patients
Accurately document patient information in EMR systems (NextGen, etc.)
Maintain clear, professional communication with patients and clinic staff
Welltality delivers meaningful healthcare support that improves patient outcomes, playing a vital role in helping patients stay proactive with their care while supporting physician practices nationwide. They value accountability, teamwork, and continuous improvement.
Manage communications between patients and doctors and associated documentation.
Collaborate with Customer Service to troubleshoot patient requests pertaining to physician requirements.
Provide clinical feedback in response to patient inquiries involving medication, lab, side effects.
Hone is an online medical clinic transforming healthcare and enhancing longevity. They use scientific advancements to empower individuals to take control of their health. Hone is a remote-first employer with a focus on people and a culture that values collaboration and joy.
Contact members via phone to schedule clinical assessment visits.
Effectively communicate service offerings and answer member questions.
Maintain performance accountability around member enrollment and participation.
Tuesday Health is a value-based palliative care provider group dedicated to transforming serious illness and end-of-life care. With a leading-edge care model, Tuesday Health is shaping the future of community-based palliative care nationwide.
Serves as a patient advocate and navigator, guiding patients and caregivers through the healthcare system.
Completes emergency room and hospital follow-up calls, offering education on alternative access points to reduce avoidable ED visits.
Facilitates medication education and adherence support, including alignment with standing orders, protocols, and chronic disease management goals.
Praxis Health is a family of medical groups providing high-quality healthcare throughout the state of Oregon. They are a company of small groups and clinics, of nimble micro-cultures that can quickly adapt to industry changes, as well as patient needs.
Handle inbound calls from patients and caregivers, providing compassionate and informed triage.
Assist with finding appropriate providers, community resources, and care solutions and coordinate priority virtual appointments.
Research information online and in Privia’s internal knowledge databases to make the most appropriate triage and care advice decisions.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. They optimize physician practices, improve patient experiences, and reward doctors. Their platform is led by top industry talent and consists of scalable operations.