Remote Care Coach for Chronic Conditions

Zohorecruit; Polska; Hybrid; PLN 95,000 - 159,000; Full time

Job summary

Vitasora Health seeks a Care Coordinator to join its remote care team, managing CCM and RPM programs for patients with chronic conditions, delivering a warm onboarding and ongoing engagement using motivational interviewing and health coaching techniques.

The role emphasizes collaboration with clinicians, documentation in EHR, and adherence to CMS/NCQA regulations while supporting diverse patient needs, including social determinants of health.

Qualifications

• Active, unencumbered RN or LPN/LVN compact license.
• Minimum 1 year of clinical experience in chronic care management, telehealth, primary care, or a related setting; 3+ years preferred.
• Demonstrated knowledge of and experience applying motivational interviewing and health coaching techniques in a clinical or patient engagement setting.
• Proficiency in EHR systems, telehealth platforms, and remote patient monitoring tools.
• Familiarity with CMS CCM guidelines, HIPAA regulations, NCQA standards, and applicable compliance requirements.

Responsibilities

• Conduct monthly outreach calls with assigned patients using motivational interviewing techniques to foster intrinsic motivation and support health goals.
• Apply health coaching to guide patients through goal-setting, behavior change planning, and accountability.
• Develop and regularly update CCM care plans based on assessments and patient priorities.
• Provide tailored health education and self-management strategies for chronic conditions with plain language communication.
• Address social determinants of health impacting engagement and access, especially in rural/underserved communities.
• Receive warm hand-offs of new patients and deliver a seamless onboarding experience.
• Complete baseline assessments to inform initial care plan development.
• Use motivational interviewing during onboarding conversations to build rapport and engagement.
• Partner with billing, clinical leadership, and referring providers for accurate onboarding and EHR setup.

Skills

motivational interviewing

health coaching

communication skills

EHR proficiency

telehealth platforms

RPM tools

Education

RN or LPN/LVN compact license

CMA (AAMA) — NCCA-accredited

CCMA (NHA) — NCCA-accredited

NCMA (NCCT) — NCCA-accredited

CMAC (AMCA) — NCCA-accredited

NAHP (NRCMA)

Tools

EHR systems

Telehealth platforms

Remote patient monitoring tools

Job description

Vitasora Health seeks a Care Coordinator to join its remote care team, managing CCM and RPM programs for patients with chronic conditions, delivering a warm onboarding and ongoing engagement using motivational interviewing and health coaching techniques.

The role emphasizes collaboration with clinicians, documentation in EHR, and adherence to CMS/NCQA regulations while supporting diverse patient needs, including social determinants of health.