Remote Care Coordinator

About The Company

Vitasora Health is at the forefront of transforming chronic care delivery across America. Our innovative platform integrates remote patient monitoring (RPM), chronic care management (CCM), and telehealth solutions to facilitate proactive, continuous care that extends beyond traditional clinical settings. By connecting patients, providers, and payers through cutting-edge technology, we aim to improve health outcomes, reduce hospitalizations, and enhance patient engagement. Our mission-driven team is dedicated to building a future where accessible, personalized healthcare is a standard, not an exception.

About The Role

The Care Coordinator plays a vital role within Vitasora Health’s remote care team, serving as a clinical anchor responsible for managing the ongoing health needs of patients enrolled in CCM and RPM programs. This position requires a blend of clinical expertise and exceptional patient engagement skills, including motivational interviewing and health coaching, to foster trust and motivate behavior change. The Care Coordinator will develop personalized care plans, support self-management, and collaborate with multidisciplinary teams to optimize patient outcomes. Rooted in our core values of respect, accountability, innovation, and unity, this role extends clinical care into the community, ensuring that patients receive comprehensive support tailored to their unique circumstances.

Qualifications

• Certified Medical Assistant (CMA), Registered Medical Assistant (RMA), Certified Clinical Medical Assistant (CCMA), National Certified Medical Assistant (NCMA), or hold an active and unrestricted Licensed Practical Nurse (LPN) or Registered Nurse (RN) license.
• Minimum of 2 years of clinical experience in chronic care management, telehealth, primary care, or related settings; 5+ years preferred.
• Proven experience applying motivational interviewing (MI) and/or health coaching techniques in clinical or patient engagement contexts.
• Proficiency with EHR systems, telehealth platforms, and remote patient monitoring tools.
• Excellent verbal and written communication skills with the ability to engage empathetically, address objections, and promote behavior change.
• Knowledge of CMS CCM guidelines, HIPAA regulations, NCQA standards, and EOC requirements.

Responsibilities

• Lead monthly outreach calls with patients, utilizing motivational interviewing to encourage behavior change and support health goals.
• Assist patients in setting personalized health objectives, developing care plans, and maintaining accountability through evidence-based coaching techniques.
• Provide culturally responsive health education and self-management strategies tailored to individual needs and health literacy levels.
• Address social determinants of health and collaborate with community resources to eliminate barriers to care, especially for underserved and rural populations.
• Act as the primary liaison between patients and their healthcare teams, ensuring seamless communication among physicians, nurses, social workers, and specialists.
• Monitor patient progress through RPM data and regular interactions; escalate clinical concerns following established protocols.
• Participate in team huddles and case reviews to align care strategies and improve patient outcomes.
• Maintain accurate, HIPAA-compliant documentation of all patient interactions and care plans within the EHR system.
• Ensure compliance with CMS, NCQA, and Joint Commission standards related to CCM and RPM programs.
• Track engagement metrics and contribute insights for program performance evaluations.
• Advocate for patients by connecting them with community resources and ensuring their preferences are prioritized in care planning.

Benefits

• Competitive compensation package aligned with industry standards.
• Comprehensive medical, vision, and dental insurance coverage.
• 401(k) retirement plan with company match.
• Paid time off and holiday leave.
• Opportunities for professional development and career growth.
• Collaborative and innovative work environment supporting work-life balance.

Equal Opportunity

Vitasora Health is an Equal Opportunity Employer (EOE). We are committed to fostering a diverse and inclusive workplace and do not discriminate based on race, color, religion, gender, sexual orientation, national origin, disability, or veteran status. We believe that diversity enriches our team and enhances our ability to serve our communities effectively.

Key skills/competency

• Remote Care Coordinator
• Chronic Care Management
• Remote Patient Monitoring
• Telehealth
• Motivational Interviewing
• Health Coaching
• Patient Engagement
• EHR Systems
• HIPAA Compliance
• Care Planning