Remote Care Navigator

Seamless Assist; Northern (KY); Hybrid; USD 29,000 - 33,000; Full time

Job summary

Seamless Assist is seeking a Remote Care Navigator – Cardiac to support medically complex CHF patients. This full-time, non-clinical position works under RN supervision, focusing on telephonic outreach, care plan support, CMS documentation, and cross-team coordination.

The ideal candidate holds an active MA credential, has 2+ years in care coordination, is proficient with EHRs, and speaks English well. US work authorization and CST/PST overlap are required.

Qualifications

• Must hold Active MA certification or equivalent credential.
• 2+ years experience in care coordination, case management, or ambulatory care.
• Familiarity with CMS PCM, CCM, and/or TCM program requirements and documentation standards.
• Proficient with care coordination software and EHR systems.
• AI fluency to leverage AI tools for efficiency.
• Based in and authorized to work in the United States, with US business hours overlap.

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 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.
• Document time, interventions, care plans, and patient goals per CMS standards.
• Maintain proactive communication with RN Care Managers, cardiologists, and PCP offices.
• Clinical assessment or medical diagnosis
• Medication prescribing or adjustments
• Interpretation of labs, imaging, or EKGs
• Clinical triage or emergency response
• In-person or home visit patient contact
• Billing or coding beyond required time-based documentation

Skills

MA Certification

Care coordination experience

CMS PCM/CCM/TCM

EHR proficient

AI fluency

US work authorization

English communication

Job description

One role. Explore the available locations and their requirements.

Requirements, working hours, and compensation can vary by location. Review the selected posting below.

REMOTE CARE NAVIGATOR – CARDIAC

Sector

Healthcare — Cardiac Care Coordination

Reports To

RN Care Manager / Clinical Supervisor

Type

Full-Time · 40 hours/week

Schedule

Monday–Friday · Weekends -Flexible business hours (US hours, CST/PST overlap required)

Rate

$21–$24 USD/hour (based on experience)

Contract

W-2

Location

100% Remote — US only (Dallas/Fort Worth area preferred)

Tools

EHR platforms, care management software, population health dashboards, CMS documentation tools

Role Overview

Our client — a cardiac care management MSO — is hiring full-time virtual Care Navigators to support a growing population of medically complex patients with cardiac conditions, primarily congestive heart failure (CHF). This is a non-clinical (non-licensed) role focused on telephonic patient outreach, care plan support, CMS-compliant documentation, and coordination across the care team. The Care Navigator works under the supervision of RN Care Managers, escalating all clinical concerns appropriately. This role plays a critical part in reducing avoidable hospitalizations and supporting patient self-management over the long term.

Key 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 elevate 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
• Clinical assessment or medical diagnosis
• Medication prescribing or adjustments
• Interpretation of labs, imaging, or EKGs
• Clinical triage or emergency response
• In-person or home visit patient contact
• Billing or coding beyond required time-based documentation

Scope Limitations — This Role Does NOT Include

• Clinical assessment or medical diagnosis
• Medication prescribing or adjustments
• Interpretation of labs, imaging, or EKGs
• Clinical triage or emergency response
• In-person or home visit patient contact
• Billing or coding beyond required time-based documentation

Experience & Skills

Required:

• Active Medical Assistant (MA) certification or equivalent clinical credential (CNA, EMT, CHW with relevant experience)
• Minimum 2 years of experience in care coordination, case management, or ambulatory care
• Familiarity with CMS PCM, CCM, and/or TCM program requirements and documentation standards
• Technologically proficient with care coordination software and/or EHRs
• AI fluency — actively uses AI tools to work faster and more efficiently.
• Must be based in and authorized to work in the United States — time zone compatibility required (US business hours, CST/PST overlap)
• Exceptional written and verbal communication in English; strong phone presence assessed at screening

Preferred:

• Knowledge of cardiac conditions — especially heart failure and associated comorbidities
• Bilingual — Spanish/English (not a must)