Care Coordinator

Pay: $45,000 - $52,000/year

Schedule: 8:00 a.m. - 5:00 p.m. Central Time.

Work model: Fully remote

Position summary

Support chronic care management for patients with complex conditions, including chronic kidney disease, hypertension, diabetes, and cardiovascular disease. Working under clinical supervision, coordinate patient outreach, create and maintain care plans, reinforce provider-directed instructions, and connect patients with providers and healthcare partners.

This role involves managing a high-volume patient panel and a structured, metric-driven workflow. SMS is the primary engagement channel, with phone outreach used when appropriate.

Patient coordination responsibilities

• Support patient enrollment and onboarding, verify program eligibility, and ensure consent documentation is completed before outreach.
• Maintain regular patient engagement and escalate inactive or non-engaged cases.
• Conduct weekly text and telephone outreach, including high-volume outbound communication and follow-up attempts.
• Meet engagement time standards aligned with Medicare chronic care management billing requirements.
• Reinforce established care plans and identify barriers such as medication access, transportation, and social needs.
• Document interactions and track engagement time accurately in the CCM platform and EHR systems.
• Maintain audit-ready records and protect patient information in accordance with HIPAA and PHI requirements.
• Facilitate access to providers and clinical staff, coordinate referrals and follow-up appointments, and support transitions after hospitalizations or emergency department visits.
• Escalate symptom concerns and medication issues to licensed clinical staff.
• Manage patient messaging workflows and collaborate with remote clinical and operational teams.

Required qualifications

• Certified Medical Assistant.
• 1-3 years of healthcare experience.
• Strong clinical assessment, communication, and documentation skills.
• Ability to work in an EHR and CCM platform simultaneously.
• Ability to manage a structured, metric-driven workflow reliably.
• Intermediate Microsoft Office skills, including Outlook and Teams.
• Availability to work 8:00 a.m. - 5:00 p.m. Central Time.

Preferred experience

• Chronic disease management experience, particularly with nephrology or chronic kidney disease populations.
• Dialysis coordination, medication adherence monitoring, and kidney transplant or specialty referrals.
• Experience in virtual care, remote nursing, or telehealth programs.
• Spanish and English bilingual skills.
• Familiarity with chronic care management regulatory requirements.
• Strong patient education and motivational interviewing skills.

Remote workspace requirements

• Home internet with download speeds of at least 25 Mbps and upload speeds of at least 10 Mbps.
• A hardwired cable, fiber, or DSL connection is recommended.
• A dedicated workspace free from ongoing interruptions to protect patient information.
• Telephony applications and equipment needed for the role are provided.

Compensation and benefits

• Bonus eligibility.
• Paid time off starting at 4 weeks for full-time employees.
• 12 paid holidays per year.
• Medical, dental, vision, and life insurance.
• Health savings account with employer match.
• Continuing medical education reimbursement for eligible roles.
• 401(k) with matching contributions up to 4% after six months of employment.
• Paid parental leave.
• Onboarding and ongoing training and development.