Remote Care Coordinator.

Seamless Assist; United States; Remote; USD 36,000 - 44,000; Full time

Job summary

Cardiac Care Alliance is hiring full-time virtual Care Coordinators to support medically complex cardiac patients, primarily with CHF. The role focuses on PCM, CCM, and TCM via telephonic outreach and documentation platforms, working with RNs and Cardiologists.

This is a remote position, with 40 hours per week, and a private workspace for PHI compliance. Active MA certification is required, along with at least 2 years in care coordination, and familiarity with CMS programs.

Qualifications

• Active MA certification or equivalent clinical credential.
• Minimum 2 years of care coordination experience.
• Strong phone communication and rapport-building skills.
• Familiarity with CMS PCM, CCM, and TCM requirements.
• Experience with care coordination software or EHRs.

Responsibilities

• Conduct structured telephonic outreach to CHF patients and other complex cardiac patients.
• Maintain a caseload of assigned patients using risk stratification to prioritize care.
• Complete initial assessments and timely follow-ups addressing symptoms, meds, adherence, and functional/psychosocial status.
• Assess home safety and SDOH barriers and elevate resource needs where appropriate.
• Advance care planning needs and specialty care follow-up.
• Review dashboards and address care gaps (wellness visits, labs, symptom monitoring).
• Provide ongoing patient education and promote self-management for CHF.
• Monitor for worsening conditions or gaps and escalate as needed.
• Support 48-hour post-discharge transitional care follow-up with medication reconciliation.

Skills

Active MA certification

Care coordination

Remote work

CMS PCM/CCM/TCM

EHR software

Job description

Location: United States

About Cardiac Care Alliance (CCA)

Cardiac Care Alliance is a Management Services Organization (MSO) committed to building a high-performance cardiovascular network. We partner with independent cardiologists to deliver value-based care (VBC) models that complement traditional fee-for-service delivery. Our mission is to improve patient access, clinical outcomes, and overall experience through proactive care coordination and evidence-based interventions.

Position Summary

CCA is hiring full-time virtual Care Coordinators to support a growing population of medically complex patients with cardiac conditions, primarily congestive heart failure (CHF). This role is integral to our population health initiatives — proactively supporting at-risk patients with data-informed outreach, continuity of care, and patient-centered engagement.

This role will focus on supporting Principal Care Management (PCM), Chronic Care Management (CCM), and Transitional Care Management (TCM) services via telephonic outreach and technology-enabled documentation platforms. Care Coordinators work collaboratively with a team of Registered Nurses and Cardiologists, escalating clinical concerns and complex care needs as appropriate.

This position does not require RN licensure, but candidates must have strong clinical acumen, attention to detail, and the ability to navigate complex care environments.

Key Responsibilities

• Conduct structured telephonic outreach to CHF patients and other complex cardiac patients
• Maintain a caseload of assigned patients, using risk stratification to prioritize care
• Complete initial assessments and timely follow-ups addressing current symptoms, medication regimen and adherence, functional and psychosocial status
• Assess home safety and social determinants of health (SDOH) barriers, including transportation, food insecurity, housing instability, and caregiver support; elevate resource needs where appropriate
• Advance care planning needs and specialty care follow-up
• Review and act on population health dashboards to address care gaps (annual wellness visits, missing labs, lack of symptom monitoring, etc.)
• Provide ongoing patient education and promote evidence-based self-management strategies for CHF
• Monitor for signs of worsening conditions or gaps in care, and elevate as needed
• Support transitional care follow-up within 48 hours post-discharge, focusing on medication reconciliation, red-flag symptom screening, and appointment scheduling
• Document time, interventions, care plans, and patient goals in the care management platform in alignment with CMS billing standards
• Maintain proactive communication with RNs, Cardiologists, PCP offices, and other clinical partners

Scope of Work – Limitations

This role is non-clinical in license and does not include:

• Clinical assessment or medical diagnosis
• Medication prescribing or adjustments
• Interpretation of diagnostic results (labs, imaging, EKGs, etc.)
• Clinical triage or emergency response
• Home visits or in-person patient contact
• Billing or coding responsibilities beyond required documentation

All clinical decision-making, care plan authorization, and treatment recommendations are made by licensed providers and/or supervising RNs.

Qualifications

Required:

• Active Medical Assistant (MA) certification or equivalent clinical credential (e.g., CNA, EMT, CHW with experience)
• Minimum 2 years of experience in care coordination, case management, or ambulatory care
• Strong interpersonal communication skills and ability to build rapport by phone
• Familiarity with CMS PCM, CCM, and/or TCM program requirements
• Technologically proficient with care coordination software or EHRs
• Ability to work independently and efficiently in a remote environment

Preferred:

• Knowledge of chronic conditions, especially heart failure and associated comorbidities
• Based in or familiar with the Dallas/Fort Worth region
• Bilingual (Spanish/English)

Position Details

• Employment Type: Full-Time, W-2 Contract
• Schedule: 40 hours per week, Monday–Friday (flexible business hours)
• Compensation: $26–$32/hour (based on experience and qualifications)
• Work Environment: 100% Remote (Dallas/Fort Worth area preferred)
• Potential for ongoing engagement or full-time employment for the right candidate
• Must have a dedicated, private workspace suitable for handling PHI, a secure internet connection, and comply with HIPAA and patient privacy policies at all times