In-Home Chronic Care Navigator

The Blue Venture Fund; Bridgeport (CT); On-site; USD 28,929 - 34,440; Full time

Job summary

Upward Health is an in-home, multidisciplinary medical group delivering 24/7 whole-person care. The Care Specialist focuses on chronic care management, primarily working in patients’ homes with some virtual visits. You will guide enrollment, coordinate care, and educate patients to improve outcomes.

Requirements include at least 2 years in related roles, a high school diploma, and a valid driver’s license. Strong communication and EMR proficiency are essential for success.

Qualifications

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

Responsibilities

• Deliver chronic care management to high-complexity patients, primarily in patients' homes (90%) with some virtual care (10%).
• Guide patients through enrollment and facilitate virtual appointments with providers.
• Coordinate care, build relationships, and educate patients to promote health and prevent hospitalizations.
• Promote improved patient outcomes through coordinated care and education.
• Document and communicate patient information to the care team.

Skills

Care Coordination

Empathy

Time Management

Communication

EMR Proficiency

Chronic Care

Bilingual

Education

High School Diploma

Tools

EMR Systems

Job description

Upward Health is an in-home, multidisciplinary medical group delivering 24/7 whole-person care. The Care Specialist focuses on chronic care management, primarily working in patients’ homes with some virtual visits. You will guide enrollment, coordinate care, and educate patients to improve outcomes.

Requirements include at least 2 years in related roles, a high school diploma, and a valid driver’s license. Strong communication and EMR proficiency are essential for success.