Chronic Care Management, Care Coordinator

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Evaluate provider SOAP notes, medical documentation, patient activities, medications, hospital admissions, referrals, lab results, and pending orders.

• Prepare succinct, patient-specific chart summaries and pinpoint discrepancies or unresolved care needs that necessitate clinical assessment.

• Develop and uphold electronic care plans under the guidance of the clinical team.

• Execute structured monthly outreach to patients or caregivers following approved workflows.

• Assess symptoms, functionality, medication adherence, patient aspirations, and obstacles to care.

• Reinforce treatment plans approved by providers and supply authorized educational materials.

• Organize appointments, referrals, records, transportation, equipment, pharmacy requirements, community resources, and communication with outside providers.

• Follow up on hospitalizations, emergency room visits, rehabilitation stays, specialist recommendations, tests, imaging, and pending orders.

• Identify and escalate urgent symptoms, abnormal findings, medication issues, and safety concerns to licensed clinical personnel.

• Document outreach efforts, care coordination, education, care-plan revisions, escalations, and follow-up tasks in the electronic health record.

• Monitor qualifying CCM time, work queues, monthly follow-up lists, and task completion.

• Safeguard patient information and adhere to HIPAA, company, client, and payer regulations.

• Engage in training, quality reviews, audits, coaching, and corrective actions.

• Operate within the non-clinical scope of the role, refraining from diagnosing, prescribing, interpreting results independently, or offering unauthorized medical advice.

⛳️ Requirements

• Minimum of one year of experience in a medical office, primary care practice, care management program, healthcare call center, home health organization, or similar healthcare environment.

• Proficient in using electronic health records and reviewing patient charts.

• Knowledgeable about common chronic conditions, medical terminology, medications, referrals, lab reports, and healthcare documentation.

• Exceptional written and verbal communication skills in English.

• Strong telephone communication and patient engagement abilities.

• High attention to detail and accuracy in documentation.

• Capability to conduct organized, patient-centered discussions using approved workflows.

• Skill in identifying missing, overdue, inconsistent, or unresolved care requirements.

• Ability to differentiate routine administrative tasks from issues needing licensed clinical evaluation.

• Strong organizational, time management, and follow-up capabilities.

• Proficient in managing multiple patients, work queues, deadlines, and monthly assignments.

• Competence in safeguarding confidential patient information and adhering to established protocols.

• Willingness to work during U.S. business hours or overnight shifts in the Philippines.

• Reliable internet connection and a private, secure remote work setting.

🏝️ Benefits

• Paid training and a structured onboarding process.

• Fully remote work arrangement.

• Company-provided laptop and noise-canceling headset, contingent on role and eligibility criteria.

• HMO health coverage, subject to company eligibility requirements.

• Annual salary increases based on performance.

• Paid Time Off to promote work-life balance and well-being.

• Retention bonuses for long-term employees.

• Referral bonus program available.

• Performance bonuses and incentive programs upon reaching six months of tenure.

• Opportunities for professional development and career advancement.

• Continuous coaching, quality assessments, and performance feedback provided.