Chronic Care Navigator — In-Home & Virtual Support

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

Job summary

Upward Health is seeking a Care Specialist to deliver chronic care management primarily in patients' homes, with some virtual care. The role involves outreach, enrollment support, coordinating care, and educating patients to improve outcomes.

Candidates should have at least 2 years in relevant roles, a high school diploma or GED, and a valid driver’s license. Multilingual abilities are a plus, and home care experience is beneficial.

Qualifications

• Minimum of 2 years relevant work experience in community health or similar roles.
• High school diploma or GED required.
• A valid driver’s license, auto liability insurance, and reliable transportation to travel within the assigned territory.
• Experience in chronic care management or working with chronically ill/elderly patients.
• Technologically proficient with basic computer skills (typing, using EMR systems).
• Experience with motivational interviewing, trauma-informed care, and care coordination.
• Strong interpersonal communication skills with the ability to engage patients and team members effectively.
• Ability to prioritize tasks, manage schedules, and work independently in an unstructured environment.
• Multi-lingual skills are a plus but not required.
• Prior home care experience is beneficial.

Responsibilities

• Outreach to patients and enrollment guidance.
• Facilitate virtual appointments with providers.
• Coordinate care and educate patients to promote adherence and outcomes.
• Engage patients in comprehensive care plans across home and community settings.

Skills

Community Health Worker

Peer Support Specialist

Medical Assistant

Motivational Interviewing

Trauma-Informed Care

Care Coordination

Interpersonal Communication

Time Management

Independent Work

Multilingual Skills

Education

High School/GED

Tools

EMR systems

Job description

Upward Health is seeking a Care Specialist to deliver chronic care management primarily in patients' homes, with some virtual care. The role involves outreach, enrollment support, coordinating care, and educating patients to improve outcomes.

Candidates should have at least 2 years in relevant roles, a high school diploma or GED, and a valid driver’s license. Multilingual abilities are a plus, and home care experience is beneficial.