[Remote] High Risk Care Coordinator

Note: The job is a remote job and is open to candidates in USA. Oasis Health Partners is focused on building healthier communities by advancing primary care and providing personalized care for seniors. As a High-Risk Care Coordinator, you will build trusted relationships with high-risk patients, support their care management, and help them adhere to their care plans through consistent outreach and clinical support.

Responsibilities

• Conduct regularly scheduled outbound outreach to high-risk patients to support ongoing care management, reduce avoidable utilization, and address gaps in care
• 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
• Perform medication reconciliation and adherence support by reviewing patient-reported medication use, identifying discrepancies, and escalating concerns to the RN or Provider
• Collect, assess, and document patient-reported symptoms, condition trends, risk indicators, and barriers to adherence within LPN scope of practice
• Provide disease-specific education, self-management reinforcement, and motivational coaching using approved materials and care pathways
• Coordinate home health services and durable medical equipment (DME) needs under RN or Provider direction to support patient safety and stability in the home
• Identify and address social determinants of health impacting high-risk patients, including access to medications, transportation, food, housing support, or financial resources
• Support coordination and monitoring for patients with complex chronic conditions, including COPD, CHF, diabetes, and hypertension, using established protocols
• Serve as a consistent point-of-contact for assigned high-risk patient panels, building trusted relationships that promote sustained engagement and accountability
• Recognize changes in patient status, emerging risks, or non-adherence patterns and escalate promptly through defined clinical pathways
• Provide feedback to Clinical Operations and Clinical Leadership to support continuous improvement of high-risk patient management programs

Skills

• Completed an accredited practical nursing (LPN) program
• At least two years of prior nursing experience in care coordination, population health, or chronic disease support
• Licensed as a Licensed Practical Nurse (LPN) and credentialed in good standing in the applicable state(s) of practice
• Experience making structured, outbound calls, preferably in a call-center environment
• Experience supporting high-risk patients with chronic conditions, care management, or utilization reduction
• Comfortable performing medication reconciliation, structured symptom monitoring, and care coordination under RN or provider oversight
• Strong patient communication skills, including the ability to engage, motivate, and support patients using patient-centered techniques
• Compassionate communicator with strong active listening abilities
• Highly organized, dependable, and emotionally intelligent, with the ability to manage ongoing patient panels
• Proficient in EHR documentation and care management or population health tracking tools
• Able to multitask effectively in a fast-paced outreach environment with strong time management and follow-through skills

Benefits

• Medical
• Dental
• Vision
• Generous time off plans

Company Overview

• Recognized as one of the 2026 Best Places to Work in Healthcare by Modern Healthcare. It was founded in 2022, and is headquartered in Columbia, South Carolina, USA, with a workforce of 51-200 employees. Its website is https://oasishealth.com.