Home-Based Chronic Care Navigator

The Blue Venture Fund; Waterbury (CT); On-site; USD 29,000 - 34,000; Full time

Job summary

Upward Health is seeking a Care Specialist to deliver chronic care management to high-complexity patients, primarily in home and community settings.

You will enroll patients, coordinate with providers, and educate families to promote adherence and improve outcomes, with 90% field work and 10% virtual care.

The role requires strong communication, empathy, and independence, plus experience in chronic care and proficiency with EMR systems.

Qualifications

• Minimum of 2 years of relevant work experience (e.g., Community Health Worker, Peer Support Specialist, Medical Assistant).
• 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

• Deliver chronic care management to high-complexity patients.
• Work in patients' homes and communities (90% of the time) and engage in virtual care (10%).
• Direct outreach to patients, guiding them through enrollment processes, and facilitating virtual appointments with providers.
• Coordinate care and provide education to promote adherence and improved outcomes.
• Build relationships with patients and families to support care plans.

Skills

Patient communication

Motivational interviewing

Care coordination

Multilingual

Education

High school diploma or GED

Tools

EMR systems

Job description

Upward Health is seeking a Care Specialist to deliver chronic care management to high-complexity patients, primarily in home and community settings.

You will enroll patients, coordinate with providers, and educate families to promote adherence and improve outcomes, with 90% field work and 10% virtual care.

The role requires strong communication, empathy, and independence, plus experience in chronic care and proficiency with EMR systems.