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CenterWell
Overview
The Care Coach provides proactive, patient-centered care coordination and social needs support for the highest risk top 5% patient membership, serving as the primary contact for patients. Duties include coordinating care across health and social service systems, conducting clinical screenings, performing home visits, addressing social needs, and delivering chronic disease education.
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Compensation
$53,700 - $72,600 / YEAR
Posted
15 days ago
The Care Coach provides proactive, patient-centered care coordination and social needs support for the highest risk top 5% patient membership, serving as the primary contact for patients. Duties include coordinating care across health and social service systems, conducting clinical screenings, performing home visits, and delivering culturally appropriate education for chronic disease management.
The Care Coach provides proactive, patient-centered care coordination and social needs support for the highest risk patient membership, serving as the primary contact for patients focusing on adherence coaching, healthcare navigation, and reinforcing care plans. Responsibilities include coordinating care across health and social service systems, conducting clinical screenings, performing home visits, and delivering culturally appropriate education for chronic disease management.
The Care Coach provides proactive, patient-centered care coordination and social needs support for the highest risk top 5% patient membership, serving as the primary contact for patients focusing on navigation and reinforcing care plans. Key duties include coordinating care across health and social systems, conducting clinical screenings, performing home visits, addressing social barriers, and delivering chronic disease education.
The Care Coach provides proactive, patient-centered care coordination and social needs support for the highest risk top 5% patient membership, serving as the primary contact for patients focusing on navigation and reinforcing care plans. Duties include coordinating care across health and social systems, conducting clinical screenings, performing home visits, addressing social needs, delivering chronic disease education, and supporting care transitions.
North Country Family Health Center Inc
The Licensed Practical Nurse (LPN) provides medical care as part of a clinical team, ensuring a smooth continuum of care for patients, many of whom are high risk. Responsibilities include facilitating patient flow, providing direct patient care under provider direction, administering immunizations and medications, and maintaining charts and cleanliness of clinical areas.
Salary not listed
24 days ago
Stormont Vail Health
The Rapid Response Nurse responds to urgent and emergent situations, providing advanced assessment and support to bedside nurses. They collaborate with healthcare teams to ensure high-quality patient care and assist with transfers to higher levels of care as necessary.
Gonzaba Medical Group
Provide direct clinical care to high-risk patients in their homes, focusing on complex wound care and treatment protocols. Coordinate with Wound Care Specialists and PCPs to ensure continuity of care and prevent hospital readmissions.
1 month ago
SouthEast Alaska Regional Health Consortium (SEARHC)
This role is responsible for actively managing SEARHC patients by coordinating the delivery of appropriate and timely care, collaborating with providers to establish individualized medical goals, and managing acute, chronic, and maintenance care needs. The RN Case Manager also performs staff nursing duties, including assessment, education, and medication administration, while ensuring efficient coordination of referrals both within SEARHC and to outside facilities.
$39 - $55 / HOUR
Mass General Brigham
The Complex Care Manager RN coordinates and supports healthcare within the facility and manages referrals for external services, focusing on outreach and enrollment for high-risk primary care patients in the Care Compass program. Primary duties include developing community service plans, partnering with providers and families to create healthcare plans, conducting client assessments, and modifying treatment plans as needed.
$58,656 - $142,449 / YEAR
UHS
The Transplant Registered Dietitian Nutritionist is responsible for providing comprehensive nutritional assessment and intervention for transplant candidates, recipients, and potentially living donors as requested. This role also involves developing and reviewing nutritional guidelines, participating in transplant-related performance improvement projects, and documenting care in the patient's medical record.
2 months ago
PRIORITY ONDEMAND
The Nurse Practitioner will conduct virtual clinical assessments for recently discharged and high-risk patients, managing care plans and completing medication reconciliation remotely. This role also involves providing real-time support to field clinicians conducting in-home visits to support readmission avoidance and care continuity.
WellSpan Health
The role involves providing genetic counseling services to high-risk patients and their families within the WellSpan Health integrated delivery system. This supports the organization's vision of reimagining healthcare through comprehensive and equitable solutions.
3 months ago
This dynamic individual will provide direct patient care to high-risk patients and indirect patient care under the direction of an RN or physician, assisting with activities of daily living and providing personal care and emotional support. Responsibilities also include completing bedside shift reports and ensuring communication boards are updated with care team information every shift.
Westside Family Healthcare Inc
The Ambulatory Care Nurse manages a caseload of at-risk patients, coordinating care and implementing prescribed medical treatment plans through patient education and self-management skill development. Responsibilities include participating in team huddles, reviewing medical records proactively, and advocating for patient needs while participating in quality improvement activities.
The Ambulatory Care Nurse manages a caseload of at-risk patients, coordinating care and implementing prescribed medical treatment plans through patient education and self-management skill development. Responsibilities include participating in team meetings, reviewing medical records proactively, and ensuring both medical and psychosocial needs are met to promote health and well-being.
The Ambulatory Care Nurse manages a caseload of high-risk patients, coordinating services across the care continuum and implementing prescribed medical treatment plans through patient education and self-management skill development. Responsibilities include participating in team huddles, proactively reviewing medical records for intervention needs, and assessing patient progress toward health goals.
The Ambulatory Care Nurse manages a caseload of at-risk patients, coordinating services and implementing prescribed medical treatment plans through patient education. Responsibilities also include participating in team huddles, reviewing medical records proactively, and assessing patient progress towards goals.
The Ambulatory Care Nurse manages a caseload of at-risk patients, coordinating care and implementing prescribed medical treatment plans through patient education and self-management skill development. Responsibilities include participating in team meetings, proactively reviewing records, assessing patient needs, and promoting preventative care and timely access to appropriate services.
The Medical Assistant delivers medical care, either in person or via telemedicine, collaborating with team members to ensure a smooth continuum of care for patients, many of whom are high risk. This involves facilitating efficient patient flow, providing direct patient care, assisting with follow-up, chart maintenance, and keeping clinical areas orderly.
