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The Care Coordinator manages a panel of patients in CCM and RPM programs, conducting outreach and providing health education. They are responsible for monitoring patient data, updating care plans, and ensuring seamless communication between patients and healthcare providers.
This is a remote position.
We are seeking a compassionate, organized, and healthcare-focused Care Coordinator to support patients enrolled in Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) programs.
The Care Coordinator will serve as an important connection between patients, healthcare providers, and the care team. This role focuses on patient engagement, chronic condition support, remote monitoring, care-plan coordination, health education, and ensuring patients receive consistent follow-up and assistance between provider visits.
The ideal candidate combines strong healthcare knowledge with excellent communication, empathy, organization, and the ability to work independently in a remote environment.
Manage an assigned panel of patients enrolled in CCM and RPM programs.
Conduct scheduled outbound calls and follow-ups with patients.
Build trusting relationships with patients and encourage ongoing participation in their care plans.
Provide basic health coaching, education, and guidance within established clinical protocols.
Identify patient concerns, barriers to care, or changes in reported condition and escalate appropriately.
Support patients with questions regarding their care-management program and remote monitoring services.
Review and monitor patient RPM data, alerts, readings, and trends.
Follow established workflows for identifying readings requiring attention or escalation.
Assist patients with proper use of RPM devices and technology.
Follow up with patients regarding missing readings, device issues, or abnormal measurements.
Document monitoring activity and patient interactions accurately.
Assist with development, implementation, and ongoing updates to individualized care plans.
Track patient goals, follow-ups, appointments, medications, and identified care needs.
Coordinate communication between patients, providers, caregivers, and other members of the care team.
Help identify gaps in care and ensure appropriate follow-up.
Coordinate referrals and connect patients with appropriate healthcare resources when directed.
Accurately document patient calls, interactions, monitoring activity, care-plan updates, and follow-up requirements.
Maintain accurate and timely records within the appropriate healthcare platforms.
Protect patient information and maintain strict HIPAA compliance.
Follow established clinical, operational, and documentation protocols.
Previous experience in a healthcare, patient-care, medical-assistant, nursing, care-coordination, or similar environment.
Strong understanding of patient communication and healthcare workflows.
Fluent in both Russian and English — required.
Excellent verbal and written communication skills in English and Russian.
Strong empathy, patience, and ability to build rapport with patients.
Excellent organization and follow-through.
Comfortable working independently in a remote environment.
Strong computer skills and ability to learn multiple healthcare technology platforms.
Reliable internet connection and professional remote workspace.
Commitment to patient privacy and HIPAA compliance.
RN, LPN/LVN, CMA, CCMA, or equivalent healthcare certification.
Experience with Chronic Care Management (CCM).
Experience with Remote Patient Monitoring (RPM) or telehealth.
Experience managing an assigned patient panel or caseload.
Experience working with chronic conditions such as diabetes, hypertension, cardiovascular disease, respiratory conditions, or other long-term health conditions.
Experience with EMR/EHR systems and remote-care platforms.
Experience with RPM devices and patient monitoring technology.
Previous patient education or health-coaching experience.
Experience coordinating referrals, appointments, medications, or follow-up care.
The ideal candidate is patient-centered, clinically knowledgeable, highly organized, bilingual, and comfortable communicating with patients remotely.
They should be confident navigating technology, capable of managing multiple patients and follow-up requirements, and comfortable identifying issues that require escalation to the appropriate healthcare professional.
Strong Russian and English communication skills are essential, as the Care Coordinator will communicate with patients and healthcare teams in both languages.
Most importantly, this person should genuinely enjoy helping patients manage chronic conditions and remain engaged in their care.
Success in this role will be demonstrated through:
Consistent and meaningful patient engagement.
Timely completion of required patient outreach and follow-ups.
Accurate RPM monitoring and escalation.
Well-maintained care plans and documentation.
Effective coordination with providers and care teams.
Strong patient communication and satisfaction.
Consistent adherence to HIPAA and program requirements.
Ability to manage workload independently and reliably.
Previous experience in a healthcare, patient-care, medical-assistant, nursing, care-coordination, or similar environment.
Strong understanding of patient communication and healthcare workflows.
Fluent in both Russian and English — required.
Excellent verbal and written communication skills in English and Russian.
Strong empathy, patience, and ability to build rapport with patients.
Excellent organization and follow-through.
Comfortable working independently in a remote environment.
Strong computer skills and ability to learn multiple healthcare technology platforms.
Reliable internet connection and professional remote workspace.
Commitment to patient privacy and HIPAA compliance.
RN, LPN/LVN, CMA, CCMA, or equivalent healthcare certification.
Experience with Chronic Care Management (CCM).
Experience with Remote Patient Monitoring (RPM) or telehealth.
Experience managing an assigned patient panel or caseload.
Experience working with chronic conditions such as diabetes, hypertension, cardiovascular disease, respiratory conditions, or other long-term health conditions.
Experience with EMR/EHR systems and remote-care platforms.
Experience with RPM devices and patient monitoring technology.
Previous patient education or health-coaching experience.
Experience coordinating referrals, appointments, medications, or follow-up care.
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