Bilingual RN Care Coach - Eligible

Overview

Bilingual Registered Nurse Care Coach - BONUS Eligible. This is a remote, part-time role (about 20-25 hrs per week) for Circle Link Health, supporting patients enrolled in Medicare's Chronic Care Management Program. The RN Care Coach will be assigned a group of patients to follow and call monthly to provide education, coordinate care, close preventive care gaps, and coach on strategies for self-management to keep patients out of the hospital.

This role requires precision, discipline, accountability, and the ability to work in a structured, performance-driven environment. Expected standards include complete and timely documentation, strong time management, and ownership of outcomes.

• Utilize our specialized care management software to call Medicare patients with 2 or more chronic conditions (e.g., Diabetes, CHF, Chronic Pain, COPD) on a monthly basis
• Build and maintain rapport with patients to coach them toward improved health through SMART goals and education on self-management strategies
• Implement and update the Plan of Care by documenting medications, due appointments, biometrics, symptoms, and interventions
• Connect patients with community resources as needed (e.g., transportation, personal care, prescription/DME assistance, social services)
• Conduct Transitional Care Management activities for high-risk patients discharged from hospital or ER to reduce readmissions
• Close care gaps by encouraging and assisting with preventive care measures (e.g., annual well visits, vaccines, cancer screens, follow-up/specialist appointments)

• Fluent in English and Spanish
• Self-directed and able to work independently with minimal supervision while meeting performance metrics
• Passion for nursing and improving patient outcomes
• Proficient with technology and eager to learn new software
• Excellent organizational and time management skills
• Strong communication and telephonic skills
• Strong critical thinking and problem-solving abilities

• Current, unrestricted RN Compact License or New Mexico RN license
• Proficiency with EPIC electronic health records and web-based applications preferred
• 3+ years of experience as a Registered Nurse

• Case Management or Chronic Disease Management experience
• Certified Diabetes Educator
• Experience with Motivational Interviewing or other behavior-change techniques

• RN requires a strong internet-connected computer (will be tested)
• Minimum of 20 hours of work availability per week between 9:00 am and 6:00 pm MST
• This is a 1099 contract position with no end date; care coaches are responsible for their own equipment, taxes, and insurance

• Compensation: $15.00 per initial Clinical Encounter per patient per month. A clinical encounter occurs after two criteria are met: a patient has a successful clinical call and the patient has 20 minutes or more in their chart timer.
• Example:
  If in one hour you called and spoke with 2 patients and spent 20 minutes with each, your pay for that hour would be $30.00 (15.00/pt reached x
  2).
• Bonus Eligibility:
  Coaches who complete 3 months of employment and meet all performance expectations are eligible for a $300 performance bonus.
• Pay Timing:
  Monthly via direct deposit, approximately every 30 days after each month (delays due to Medicare processing and documentation).

Circle Link Health is a team of clinicians, technologists, and professionals tackling the preventable chronic and post-acute complications burden. We are building a care management platform to enable providers and promote preventative care.