Remote Cardiac Care Navigator - Telehealth Coordination

Seamlessassist; Albuquerque (NM); Remote; USD 29,000 - 33,000; Full time

Job summary

Seamlessassist is hiring a Remote Care Navigator for Cardiac care management. This full-time, non-clinical role involves telephonic outreach, care plan support, CMS-compliant documentation, and coordination with the care team to reduce hospitalizations.

You will work under RN supervision, perform structured patient outreach for CHF and complex cardiac patients, update dashboards, and ensure timely follow-up within CMS guidelines.

Qualifications

• Active MA certification or LVN/LPN license.
• Minimum 2 years in care coordination, case management, or ambulatory care.
• Familiarity with CMS PCM, CCM, and/or TCM documentation standards.
• Technologically proficient with care coordination software and/or EHRs.
• AI fluency and use of AI tools to work faster and more efficiently.
• Must be based in and authorized to work in the United States (US hours, CST/PST overlap).
• Exceptional written and verbal communication in English.

Responsibilities

• 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 - medication reconciliation, red-flag symptom screening, appointment scheduling.
• Provide patient education on CHF self-management and evidence-based strategies.
• Monitor for signs of worsening conditions or care gaps and escalate to supervising RN.
• Review and act on population health dashboards to address care gaps (wellness visits, labs, symptom monitoring).
• Document time, interventions, care plans, and patient goals per CMS billing standards.
• Maintain proactive communication with RN Care Managers, cardiologists, and PCP offices.

Skills

AI fluency

English fluency

Phone communication

Education

Medical Assistant certification (MA)

LVN/LPN license

Tools

Care coordination software

EHR systems

Job description

Seamlessassist is hiring a Remote Care Navigator for Cardiac care management. This full-time, non-clinical role involves telephonic outreach, care plan support, CMS-compliant documentation, and coordination with the care team to reduce hospitalizations.

You will work under RN supervision, perform structured patient outreach for CHF and complex cardiac patients, update dashboards, and ensure timely follow-up within CMS guidelines.