High Risk Care Coordinator at Oasis Health Partners®

RemoteFull-timeRemotePatient EngagementPosted about 1 month ago

About the Role

Who You Are    You are a Licensed Practical Nurse (LPN) who thrives on connecting with people through compassionate communication. You easily build meaningful relationships and support positive behavior change through partnership rather than pressure. Leveraging your practical nursing knowledge and structured care protocols, you help patients clearly understand and follow their provider-directed care plans. You bring grace under pressure and feel energized by supporting high-risk patients as they work toward improved health and stability.  Who We Are   Oasis Health Partners (Oasis) is building healthier communities by advancing primary care.  We partner with patients, providers and plans to provide personalized, local care for seniors in towns across America.  We believe that patients’ needs come first, and that primary care is the foundation of patient-centric healthcare. With Oasis, patients receive better access and care. Providers receive the data, resources and expertise to be successful in value-based care arrangements. Payors get the benefit of a solution that improves performance, drives growth and reduces the total cost of care in hard-to-engage markets.       Together, we will boldly advance primary care for those that need it most. We are excited for you to join us on this journey. We invite you to be a part of Oasis, where you’ll discover we listen first, do the right thing, build things together and go all in --- while having fun!   Your Role As a High-Risk Care Coordinator, you build trusted, ongoing relationships with high-risk patients through consistent outreach, active listening, and structured clinical support. You regularly engage patients by phone and text to address complex medical and social needs, including medication management, chronic condition monitoring, and barriers to care. Using patient-centered discussion and established care protocols, you support patients in understanding and adhering to provider-directed care plans while identifying emerging risks that require escalation. This role is part of a new high-risk patient management program being built from the ground up. You will have the opportunity to help shape workflows, outreach strategies, and processes that truly work for patients and care teams.  Additional Responsibilities:   <ul> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="0" data-aria-level="1">Conduct regularly scheduled outbound outreach to high-risk patients to support ongoing care management, reduce avoidable utilization, and address gaps in care.</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="0" data-aria-level="1">Contribute to the development of a new high-risk patient management program by helping design, test, and refine outreach workflows, documentation practices, and care coordination processes in a growing, non–enterprise EHR environment.</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="0" data-aria-level="1">Perform medication reconciliation and adherence support by reviewing patient-reported medication use, identifying discrepancies, and escalating concerns to the RN or Provider.</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="0" data-aria-level="1">Collect, assess, and document patient-reported symptoms, condition trends, risk indicators, and barriers to adherence within LPN scope of practice.</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="0" data-aria-level="1">Provide disease-specific education, self-management reinforcement, and motivational coaching using approved materials and care pathways.</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="0" data-aria-level="1">Coordinate home health services and durable medical equipment (DME) needs under RN or Provider direction to support patient safety and stability in the home.</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="0" data-aria-level="1">Identify and address social determinants of health impacting high-risk patients, including access to medications, transportation, food, housing support, or financial resources.</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="0" data-aria-level="1">Support coordination and monitoring for patients with complex chronic conditions, including COPD, CHF, diabetes, and hypertension, using established protocols.</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="0" data-aria-level="1">Serve as a consistent point-of-contact for assigned high-risk patient panels, building trusted relationships that promote sustained engagement and accountability.</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="0" data-aria-level="1">Recognize changes in patient status, emerging risks, or non-adherence patterns and escalate promptly through defined clinical pathways.</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="0" data-aria-level="1">Provide feedback to Clinical Operations and Clinical Leadership to support continuous improvement of high-risk patient management programs. </li> </ul> Investment In Our Team    We invest in the personal and professional success of our team. We take care of our people and offer robust benefits including medical, dental, vision and generous time off plans. We are committed to supporting your growth with a development program that starts with onboarding and continues throughout your career. As an inclusive, passionate and diverse team, you will partner with professionals who understand the importance of high-value, high-impact patient care.      We invite you to be a part of Oasis, where you’ll discover we listen first, build things together, always do the right thing, have fun and most importantly, are all in!    About You   <ul> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="11" data-aria-level="1">You have completed an accredited practical nursing (LPN) program, with at least two years of prior nursing experience in care coordination, population health, or chronic disease support</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="11" data-aria-level="1">Licensed as a Licensed Practical Nurse (LPN) and credentialed in good standing in the applicable state(s) of practice</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="11" data-aria-level="1">Experience making structured, outbound calls, preferably in a call-center environment, and feel confident engaging patients proactively by phone</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="11" data-aria-level="1">Experience supporting high-risk patients with chronic conditions, care management, or utilization reduction preferred</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="11" data-aria-level="1">Comfortable performing medication reconciliation, structured symptom monitoring, and care coordination under RN or provider oversight</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="11" data-aria-level="1">Experience making structured outbound call calls, preferably in a call-center environment, enjoy and feel confident engaging patients proactively by phone</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="11" data-aria-level="1">Strong patient communication skills, including the ability to engage, motivate, and support patients using patient-centered techniques</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="11" data-aria-level="1">Compassionate communicator with strong active listening abilities</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="11" data-aria-level="1">Highly organized, dependable, and emotionally intelligent, with the ability to manage ongoing patient panels</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="11" data-aria-level="1">Proficient in EHR documentation and care management or population health tracking tools</li> <li data-leveltext="•" data-font="Avenir Book" data-listid="14" data-list-defn-props="{"335551671":0,"335552541":1,"335559685":720,"335559991":360,"469769226":"Avenir Book","469769242":[8226],"469777803":"left","469777804":"•","469777815":"hybridMultilevel"}" data-aria-posinset="11" data-aria-level="1">Able to multitask effectively in a fast-paced outreach environment with strong time management and follow-through skills </li> </ul><div class="content-pay-transparency"><div class="pay-input"><div class="title">Hourly Pay Range</div><div class="pay-range">$33.65—$48.08 USD</div></div></div><div class="content-conclusion">The posted salary range reflects the broader pay range for the level associated with this role. Because the range is designed to support growth over time, starting salaries are typically aligned to a candidate's experience and demonstrated scope relative to the role. At this time, we are unable to sponsor employment visas. Candidates must be authorized to work in the United States without a current or future visa sponsorship. This role is open to applicants currently residing in the United States. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, protected veteran status, or disability status.</div>

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