Chronic Care Navigator — Home Visits & Virtual Care

Upward Health, Inc.; Rio Rancho (NM); On-site; USD 29,000 - 33,000; Full time

Job summary

Upward Health, Inc. in New Mexico is seeking a Care Specialist to deliver chronic care management primarily in patients' homes, with some virtual visits. The role centers on enrollment, care coordination, and education to improve outcomes.

You will travel within the assigned territory, rely on strong communication, motivational interviewing, and EMR proficiency to build rapport and ensure adherence to care plans.

Qualifications

• Minimum of 2 years of relevant work experience in health outreach or care coordination.
• High school diploma or GED required.
• Valid driver's license and reliable transportation.
• Experience with chronic care management or elderly patients.
• Proficient with basic computer skills and EMR systems.
• Experience with motivational interviewing and trauma-informed care.
• Strong interpersonal and communication skills.

Responsibilities

• Outreach to patients and guide enrollment in care plans.
• Facilitate virtual appointments with providers.
• Travel within assigned territory to patient homes.
• Educate patients to promote adherence and reduce hospitalizations.
• Document activities accurately in EMR.
• Collaborate with care teams to coordinate services.

Skills

Community Health Worker

Medical Assistant

Motivational Interviewing

Care Coordination

Empathy & Communication

EMR Systems

Education

High school diploma or GED

Tools

EMR software

Job description

Upward Health, Inc. in New Mexico is seeking a Care Specialist to deliver chronic care management primarily in patients' homes, with some virtual visits. The role centers on enrollment, care coordination, and education to improve outcomes.

You will travel within the assigned territory, rely on strong communication, motivational interviewing, and EMR proficiency to build rapport and ensure adherence to care plans.