Remote Cardiac Care Navigator — AI-Driven, Non-Clinical

Seamlessassist; McAllen (TX); À distance; USD 29 000 - 33 000; Plein temps

Résumé du poste

Seamlessassist is seeking a remote Care Navigator to support medically complex cardiac patients, mainly CHF, in a non-clinical telephonic role. You will coordinate care plans, document CMS-compliant activities, and work with the care team to reduce hospitalizations.

This full-time US-only position requires strong English communication, AI-enabled workflow use, and proficiency with EHRs and care management software. Certification and prior care coordination experience are expected.

Qualifications

• Active MA certification or LVN/LPN license.
• At least 2 years in care coordination or case management.
• Familiar with CMS PCM/CCM/TCM requirements and documentation standards.
• Proficient with care coordination software and EHRs.
• English communication and US work authorization.

Responsabilités

• Conduct structured telephonic outreach to CHF and complex cardiac patients.
• Maintain an assigned patient caseload using risk stratification to prioritize outreach.
• Complete initial assessments and follow-ups covering symptoms, medications, psychosocial status, and SDOH barriers.
• Support Transitional Care Management (TCM) follow-up within 48 hours post-discharge.
• Provide patient education on CHF self-management and evidence-based strategies.
• Monitor for worsening conditions or care gaps and escalate to supervising RN.
• Review population health dashboards to address care gaps.
• Document time, interventions, care plans, and patient goals per CMS standards.
• Maintain proactive communication with RNs, cardiologists, and PCP offices.

Connaissances

Care coordination

CMS documentation standards

EHR proficiency

AI fluency

English communication

Formation

Active MA certification

LVN/LPN license

Outils

EHR software

CMS documentation tools

Population health dashboards

Description du poste

Seamlessassist is seeking a remote Care Navigator to support medically complex cardiac patients, mainly CHF, in a non-clinical telephonic role. You will coordinate care plans, document CMS-compliant activities, and work with the care team to reduce hospitalizations.

This full-time US-only position requires strong English communication, AI-enabled workflow use, and proficiency with EHRs and care management software. Certification and prior care coordination experience are expected.