Job Description
Job DescriptionJob Title: Clinical Care Coordinator (Remote) – Text-Based APCM Program
Department: Clinical Operations
Location: Remote (designated roles available in CST)
Reports To: Clinical Programs Manager / Associate Director of Clinical Services
Position Type: Full-Time
About the Role
We are seeking a compassionate, organized, and tech-savvy Clinical Care Coordinator to support patients with chronic conditions in our text-based Advanced Primary Care Management (APCM) program. This remote role focuses on delivering proactive, high-quality care through digital communication tools, driving better health outcomes for Medicare and older adult populations.
This position is ideal for healthcare professionals who thrive in a virtual care setting, value patient engagement, and are skilled in critical thinking and care coordination.
Prioritizing hires in Illinois in the initial launch. Candidates in other locations may apply; however, applications will be held until additional resources are needed outside of the initial target areas.
Key Responsibilities
- Serve as the first line of communication for patients via a secure, text-based platform
- Monitor and respond to patient messages and check-ins in a timely, compassionate, and professional manner
- Identify, assess, and triage clinical concerns, SDOH needs, and care coordination barriers
- Collaborate with RNs, NPs, and Social Workers to ensure timely escalation and follow-through
- Develop and update personalized care plans for patients with chronic conditions (e.g., hypertension, diabetes, COPD)
- Track engagement, log care time, and document all communication per HIPAA and program guidelines
- Support monthly billing processes by ensuring all time and care plans are accurately recorded
- Participate in daily huddles, team meetings, and ongoing training to improve patient outcomes and workflows
- Provide warm, empathetic communication while navigating diverse patient populations and needs
Key Skills & Qualifications
- CMA, CCMA, RMA, or LPN/LVN compact license required
- 2+ years of experience in a clinical or care coordination role (primary care, chronic care management, home health, etc.)
- Strong critical thinking and problem-solving skills in a fast-paced environment
- Ability to independently manage a digital patient panel and prioritize escalations effectively
- Excellent written communication and documentation skills
- Comfort using EMRs (Epic specifically), care coordination platforms, and digital messaging tools
- Demonstrates strong autonomy and rapid learning ability
- Knowledge of Medicare CCM/APCM programs is a plus
- Bilingual (Spanish) is a bonus, but not required
- Must be located within the continental United States and have access to reliable internet and the ability to work in a specified time zone - either CST, EST, or PST, depending on client and candidate location
- Access to Internet 5G
Schedule & Work Environment
- Full-time, Monday - Friday
- Flexible remote schedule across CST, EST, or PST time zones
- 1-hour lunch break, daily huddles with manager/team
- Ongoing support from a multidisciplinary care team
Why Join Us?
- Mission-driven organization focused on health equity and innovative digital care
- Collaborative, diverse, and growth-focused culture
- Opportunities for professional development and internal promotion
- Competitive compensation and benefits package
- Be part of redefining how care is delivered—one text at a time