Integrated Care Coach

The Care Coach provides proactive, patient-centered care coordination and social needs support for high-risk patient membership, serving as the primary contact for care coordination, adherence coaching, and healthcare navigation. This role involves conducting structured patient interviews, performing home visits, and connecting patients with community-based resources to address social barriers and chronic disease management. The position requires collaboration with primary care providers, specialists, and community partners to create comprehensive care plans and ensure safe transitions of care.