Bilingual Care Navigator for High-Risk Patients

CenterWell Senior Primary Care; Las Vegas (NV); On-site; USD 60,000 - 90,000; Full time

Job summary

CenterWell Senior Primary Care is seeking a Care Coach to provide proactive, patient-centered care coordination and social needs support for the highest risk top 5% patient membership. You will be the primary contact for patients, focusing on adherence coaching, healthcare navigation, transitions of care and reinforcing care plans.

You will report to a Care Integration Team Manager within the CenterWell and Conviva Primary Care organization, conducting home visits, coordinating with primary

Qualifications

• Must have healthcare experience in ambulatory/primary care or senior care and be able to discuss chronic conditions.
• Ability to conduct home visits and outreach to communities.
• Experience in patient education, care coordination and supporting high‑risk/geriatric populations.

Responsibilities

• Clinical Screening & Escalation: conduct structured patient interviews and collect health data; share findings with providers.
• Outreach and Home Visits: perform visits to observe living conditions and safety concerns influencing engagement.
• Social Needs support: identify barriers and connect patients with community resources.
• Chronic Disease Education: provide culturally appropriate education to reinforce care plans.
• Care Coordination: liaise between patients, primary care, specialists, pharmacies, home health.
• Post-Hospital and ED Follow-Up: ensure safe transitions and schedule follow-ups.
• Community Engagement: promote connections to community programs supporting health goals.
• Cultural Competence: deliver patient-centered, culturally sensitive care.

Skills

Care coordination

Patient education

Home visits

Social support

Geriatrics

Education

LPN/LVN license or MA Certification

Job description

CenterWell Senior Primary Care is seeking a Care Coach to provide proactive, patient-centered care coordination and social needs support for the highest risk top 5% patient membership. You will be the primary contact for patients, focusing on adherence coaching, healthcare navigation, transitions of care and reinforcing care plans.

You will report to a Care Integration Team Manager within the CenterWell and Conviva Primary Care organization, conducting home visits, coordinating with primary