754 Healthcare jobs in Piedmont

Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description:

The Care Specialist - ECM is responsible for coordinating care for high-complexity patients, mainly working in the field to provide chronic care coordination and support. This role involves direct outreach to patients through phone calls, home visits, and community interactions. The Care Specialist primarily works in patients' homes and communities (90% of the time) and engages in virtual or telephonic support (10% of the time) The Care Specialist will assess patient needs, help set health goals, and ensure that patients receive the appropriate care and resources, with a focus on increasing access to preventative care, reducing emergency room visits, and enhancing self-management. The role requires excellent communication skills, critical thinking, and the ability to work independently and adapt to evolving challenges.

Skills Required:

• At least 2 years of relevant work experience as a Community Health Worker, Peer Support Specialist, Medical Assistant, or in a similar role.
• High school diploma or GED required.
• A valid driver’s license and auto liability insurance.
• Reliable transportation and the ability to travel within assigned territory or as needed.
• Experience in care coordination for individuals with chronic conditions, behavioral health conditions, or with  patients experiencing housing insecurities including homelessness.
• Strong interpersonal and motivational interviewing skills to build trust and rapport with patients.
• Familiarity with trauma-informed care, care coordination, and patient education.
• Proficiency in the use of electronic medical records (EMR) systems and basic computer skills.
• Technologically savvy and able to manage documentation and data entry effectively.
• Ability to work independently in a field-based environment and as part of a team.
• Multi-lingual capabilities preferred but not required.
• Prior home care or Enhanced Care Management experience a plus.
• Community Health Worker certification is a plus.

Key Behaviors:

Adaptability: 

• Ability to work in dynamic, unstructured environments, pivoting quickly to meet the needs of patients and the organization.

Critical Thinking & Problem Solving: 

• Demonstrates strong problem-solving skills when assessing patient needs and determining the best course of action.

Motivational Interviewing & Empathy: 

• Uses motivational interviewing techniques to build rapport, set health goals, and empower patients to take charge of their care.

Relationship Building: 

• Skilled in establishing trust and fostering strong relationships with patients, families, and team members.

Self-Starter: 

• Takes initiative to perform outreach, complete assessments, and follow through with care coordination independently.

Organizational Skills: 

• Excellent at managing time, tasks, and schedules, ensuring that all patient needs are addressed in a timely manner.

Resilience: 

• Demonstrates resilience in challenging situations and remains focused on the goal of improving patient outcomes despite setbacks.

Cultural Competence: 

• Demonstrates sensitivity to and understanding of diverse cultural backgrounds, ensuring that care is provided in a culturally inclusive manner.

Commitment to Quality Care: 

• Shows passion for delivering high-quality care and support to patients, ensuring their well-being and satisfaction.

Competencies:

Care Coordination: 

• Ability to assess patient needs, coordinate care with interdisciplinary teams, and ensure patients are receiving the appropriate services.

Patient Advocacy: 

• Supports patients by navigating healthcare systems, advocating for needed resources, and ensuring timely access to care.

Health Education & Communication: 

• Educates patients about their health conditions, treatments, and the healthcare system in a clear and empathetic manner.

Data Management & Reporting: 

• Proficient in documenting patient interactions and maintaining accurate, up-to-date records in EMR systems.

Patient Outreach & Engagement: 

• Proactively reaches out to patients through multiple communication channels, including phone, in-person visits, and community outreach.

Goal Setting & Self-Management: 

• Works with patients to develop self-care plans, emphasizing shared decision-making and increasing the patient’s ability to manage their own health.

Collaboration & Teamwork: 

• Works effectively as part of an interdisciplinary care team to achieve organizational goals and improve patient outcomes.

Crisis Management & Flexibility: 

• Demonstrates flexibility and adaptability in managing unforeseen challenges, providing support where it is needed most.

Technical Proficiency: 

• Skilled in using healthcare software applications and systems for accurate data entry and patient management.

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.

Compensation details: 24-27 Hourly Wage

PI6d94951c463b-34600-38243920

Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description:

The Care Specialist - ECM is responsible for coordinating care for high-complexity patients, mainly working in the field to provide chronic care coordination and support. This role involves direct outreach to patients through phone calls, home visits, and community interactions. The Care Specialist primarily works in patients' homes and communities (90% of the time) and engages in virtual or telephonic support (10% of the time) The Care Specialist will assess patient needs, help set health goals, and ensure that patients receive the appropriate care and resources, with a focus on increasing access to preventative care, reducing emergency room visits, and enhancing self-management. The role requires excellent communication skills, critical thinking, and the ability to work independently and adapt to evolving challenges.

Skills Required:

• At least 2 years of relevant work experience as a Community Health Worker, Peer Support Specialist, Medical Assistant, or in a similar role.
• High school diploma or GED required.
• A valid driver’s license and auto liability insurance.
• Reliable transportation and the ability to travel within assigned territory or as needed.
• Experience in care coordination for individuals with chronic conditions, behavioral health conditions, or with  patients experiencing housing insecurities including homelessness.
• Strong interpersonal and motivational interviewing skills to build trust and rapport with patients.
• Familiarity with trauma-informed care, care coordination, and patient education.
• Proficiency in the use of electronic medical records (EMR) systems and basic computer skills.
• Technologically savvy and able to manage documentation and data entry effectively.
• Ability to work independently in a field-based environment and as part of a team.
• Multi-lingual capabilities preferred but not required.
• Prior home care or Enhanced Care Management experience a plus.
• Community Health Worker certification is a plus.

Key Behaviors:

Adaptability: 

• Ability to work in dynamic, unstructured environments, pivoting quickly to meet the needs of patients and the organization.

Critical Thinking & Problem Solving: 

• Demonstrates strong problem-solving skills when assessing patient needs and determining the best course of action.

Motivational Interviewing & Empathy: 

• Uses motivational interviewing techniques to build rapport, set health goals, and empower patients to take charge of their care.

Relationship Building: 

• Skilled in establishing trust and fostering strong relationships with patients, families, and team members.

Self-Starter: 

• Takes initiative to perform outreach, complete assessments, and follow through with care coordination independently.

Organizational Skills: 

• Excellent at managing time, tasks, and schedules, ensuring that all patient needs are addressed in a timely manner.

Resilience: 

• Demonstrates resilience in challenging situations and remains focused on the goal of improving patient outcomes despite setbacks.

Cultural Competence: 

• Demonstrates sensitivity to and understanding of diverse cultural backgrounds, ensuring that care is provided in a culturally inclusive manner.

Commitment to Quality Care: 

• Shows passion for delivering high-quality care and support to patients, ensuring their well-being and satisfaction.

Competencies:

Care Coordination: 

• Ability to assess patient needs, coordinate care with interdisciplinary teams, and ensure patients are receiving the appropriate services.

Patient Advocacy: 

• Supports patients by navigating healthcare systems, advocating for needed resources, and ensuring timely access to care.

Health Education & Communication: 

• Educates patients about their health conditions, treatments, and the healthcare system in a clear and empathetic manner.

Data Management & Reporting: 

• Proficient in documenting patient interactions and maintaining accurate, up-to-date records in EMR systems.

Patient Outreach & Engagement: 

• Proactively reaches out to patients through multiple communication channels, including phone, in-person visits, and community outreach.

Goal Setting & Self-Management: 

• Works with patients to develop self-care plans, emphasizing shared decision-making and increasing the patient’s ability to manage their own health.

Collaboration & Teamwork: 

• Works effectively as part of an interdisciplinary care team to achieve organizational goals and improve patient outcomes.

Crisis Management & Flexibility: 

• Demonstrates flexibility and adaptability in managing unforeseen challenges, providing support where it is needed most.

Technical Proficiency: 

• Skilled in using healthcare software applications and systems for accurate data entry and patient management.

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.

Compensation details: 24-27 Yearly Salary

PIf671dc13f1df-34600-37377122

Position Summary:

The RT Vent Field Clinician is a Respiratory Therapist providing respiratory patient care to Vent patients for optimal outcomes. Provides respiratory care to patients in alternate sites in accordance with AdaptHealth's policies and procedures. Respiratory care will be preventative, rehabilitative, and palliative in nature. The RT will utilize all the resources available within the agency and community to accomplish care objectives. This position will provide education and care to the patient and communicate with team, physicians and referral sources and other patient agencies ensuring prompt attention to patient care issues.

Essential Functions and Job Responsibilities:

• Utilizes various sources of information to attain greater competence about his or her position, including attending educational events (including attending optional in-services) and asking questions.
• Utilizes acquired knowledge to increase his or her competencies.
• Consistently demonstrates ability to adequately complete all documentation and charting procedures in compliance with company policy and procedures.
• Maintains complete and accurate patient files by updating all documents per company policy and procedures.
• Reviews Plan of Treatments and Care Plans to assure they are accurate and up to date.
• Documents procedures including how the patient tolerated a procedure, side effects and other pertinent information.
• Assists with authorization for Ventilator referrals for patients.
• Shows adequate knowledge of respiratory equipment and displays ability to utilize knowledge in the clinical setting.
• Displays knowledge of assessment skills and demonstrates application of clinical skills during set-ups, follow-ups, and in-services.
• Participates in discharge planning of highly technical cases.
• Performs clinical assessments as needed and reports results and recommendations to the referral and physician.
• Participates in highly technical discharges and prepares in advance to assure the patient and caregivers have a smooth transition to the home setting.
• Performs in-services to hospital staff, referrals, other professionals regarding equipment & issues of clinical nature.
• Follows up with physician and referrals regarding patient status and documents accurately and in a timely manner.
• Retain knowledge of and consistently adhere to procedures for the use of Personal Protective Equipment (PPE), infection control and hazardous materials handling.
• Works to promote AdaptHealth by new program development, operational backup, personal visits, coordination of educational activities, etc.
• Assume on-call responsibilities during non-business hours in accordance with company policy.
• Uses clinical expertise in evaluating vent patients records once a ventilator set up has been completed by the branch Respiratory Therapist.
• Ensures accuracy of prescriptions and plan of care was followed and documented. Also reviews delivery tickets, home inspection, ventilator check, and patient equipment competencies are complete and documented.
• Maintains proficient knowledge of ventilator patients including compliance software, new technology, units, and supplies supported by Adapthealth.
• Ability to demonstrate and instruct on use of vent units and supplies. Ability to make decisions for patients based on compliance data and assessment.
• Communicates with team, physicians and referral sources and other patient agencies ensuring prompt attention to patient care issues.
• Maintains working knowledge of Medicare/Medicaid and other third-party payer guidelines related to ventilation.
• Electronically documents patient care activity, intervention provided and all communication regarding the patient. Documentation is accurate, complete and follows company standards.
• Appropriate steps taken to ensure recommendations and orders sent are acknowledged and followed up in a timely manner.
• Responsible for accuracy, clarity, and timeliness of verbal and written communications as it relates to role.
• Responsible for documentation that supports data collection to track and trend outcomes.
• Assists in establishing clinical documentation when needed for third party reimbursement or justification.
• Uses knowledge in working with referral sources to educate about best practice standards.
• Works collaboratively and pro-actively with peers and other team members to resolve issues and assure optimum outcomes for patients, referral sources and staff.
• Acts as a resource on practices and processes to provide appropriate guidance.
• Develop and maintain working knowledge of current HME products and services offered by the company.
• Maintain patient confidentiality and function within the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliant with AdaptHealth's Compliance Program.
• Perform other related duties as assigned during and outside of normal business hours as needed.

Competency, Skills, and Abilities:

• Experience with ventilator patients
• Competent in Ventilator, Airway Clearance, and Oxygen therapy administration and management
• Able to perform clinical assessments.
• Equipment troubleshooting and maintenance skills.
• Decision making skills.
• Expert communication and interpersonal skills
• Ability to prioritize tasks and manage multiple projects.
• Strong analytical and problem-solving skills with attention to detail
• Proficient use of Microsoft Office Suite – Excel, Word, and PowerPoint
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.
• Knowledge of the regulatory requirements at the state, federal, and local level
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
• Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.

Education and Experience Requirements:

• Associates degree from an AMA approved respiratory program,
• Valid and unrestricted RT clinical license in all states serviced by the branch.
• Must be CPR certified,
• One (1) year of clinical experience as a Health Care RT, HME RT or clinical nursing with Vent experience.
• Valid and unrestricted driver's license

Physical Demands and Work Environment:

• Must be able to lift 50 pounds, stand, bend, stoop, and be able to sit at a computer for extended periods of time.
• Must be able to perform one-man CPR.
• Ability to perform repetitive movements of the upper extremities' motions of wrists, hands, and/or fingers due to extensive computer use.
• May be exposed to unsanitary conditions in some home settings.
• Work environment may be stressful at times, as overall office activities and work levels fluctuate.
• May be exposed to high crime areas within the service community.
• Subject to long periods of sitting and exposure to computer screen.
• May be exposed to hazardous materials, loud noise, extreme heat/cold, direct, or indirect contact with airborne, bloodborne, and/or other potentially infectious pathogen.
• May be exposed to angry or irate customers or patients.
• Must be able to drive and travel as needed.
• Physical and mental ability to provide clinical assessments.
• Requires travel throughout service area.
• Mental ability to communicate both verbally and in writing.
• Must be able to access the patient's residence.
• Ability to work outside of normal business hours.
• Physical and mental ability to provide clinical assessments.

PI5d14918208d2-34600-37054867

CARE SPECIALIST - ENHANCED CARE MANAGEMENT

Are you a dedicated individual with a passion for providing quality care and making a positive impact in the lives of others? If you possess a unique blend of skills and attributes, including critical thinking, resilience, and the ability to thrive in unstructured environments, we invite you to consider joining our team as a Care Specialist.

As a Care Specialist, you will play a crucial role in our organization, working in a dynamic and ever-changing field. Your responsibilities will extend beyond the ordinary, and we are looking for someone who possesses the tenacity, resilience, and perseverance to excel in challenging situations.

Your role will require you to be a self-starter, someone who not only understands the art of prioritization but is also keen to understand the "why" behind what we do. You'll engage with individuals from diverse backgrounds and often with complex needs, so the ability to work with difficult people and always be willing to help is a must. You don't just say "no"; you ask "how" and seek the "why

Your awareness of community and diversity will be vital in ensuring that you provide culturally sensitive and inclusive care. Organizational skills, responsiveness, and flexibility are key as you navigate the ever-evolving landscape of healthcare.

Your self-motivation and ability to pivot, serving as a change agent when necessary, will be highly valued. You have an outcome-oriented approach and are willing to learn, adapting to new challenges and opportunities with enthusiasm.

Criticism doesn't deter you; you take it as a chance for self-improvement and growth. Self-awareness is your ally, and you thrive as an independent problem solver. Your passion for people is the driving force behind your commitment to delivering high-quality care.

If you possess these qualities and are ready to embrace a role that demands dedication, adaptability, and a deep desire to make a positive impact, we encourage you to explore the possibilities of becoming a Care Specialist within our organization. Join us in our mission to provide exceptional care and support to those who need it most.

Who is Upward Health

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our providers, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health!

What you will do.

The Care Specialist works in patient’s homes and community 90% of the time and virtually the other 10% to deliver chronic care management to high complexity patients. During initial outreach the Care Specialist informs patients about our services and helps them get enrolled.  Reaching out via phone is our top strategy for outreach and it’s important that the Care Specialist is comfortable and confident communicating by phone.  Field-based approaches are utilized as well, and the Care Specialist should be prepared to use whatever strategy is most effective.   Once the patient is enrolled, the Care Specialist will coordinate care from the patient’s home or the community to support our integrated care delivery model, focused on the following goals: Promote timely access to appropriate care; increase utilization of preventative care; reduce emergency room utilization and hospital readmissions; create and promote adherence to a care plan developed in coordination with the patient, primary care provider, and family/caregiver(s); increase patient’s ability for self-management and shared decision-making; provide medication reconciliation; connect patients to relevant community resources, with the goal of enhancing patient health and well-being, increasing patient satisfaction, and reducing health care costs

KEY RESPONSIBILITIES:

• Conduct direct outreach to patients via phone, in-person, mailings, and other strategies including cold calling and unscheduled door knocks. 
• Enroll patients into Upward Health’s program and collect key data about patients during the enrollment process through continuous and on-going phone and in-person interactions. 
• Meets patients in their home or in the community to conduct a needs assessment, including helping patients to set health goals.
• Coordinate care between patients and interdisciplinary care teams as needed. 
• Support your patients in meeting their healthcare goals as it relates to Quality measures.
• Work within an interdisciplinary team to support the team’s effort in meeting market and/or organizational goals. 
• Analyze patient data to determine patient needs or treatment goals.
• Assess physical conditions of patients to aid in diagnosis, treatment; and/or need for additional referrals in support of health and social needs.
• Explain technical medical information to educate the patients.
• Cultivate and support the primary care providers with timely communication, inquiry follow-up, and integration of information into the care plan regarding transitions-in-care and referral.
• Builds rapport with Upward Health patients utilizing motivational interviewing techniques.
• Conduct one-on-one extended in-person patient appointments.
• Makes follow-up calls and home visits to patients per Upward Health policy.
• Documents each patient encounter with accuracy and precision.
• Prepares reports and documents as needed or requested.
• Attends regular daily huddle, team meetings and participates in clinical rounds.
• Other duties as needed. 

KNOWLEDGE, SKILLS & ABILITIES:

• Strong critical thinking skills for assessing patient needs and treatment goals.
• Self-starter with the ability to work independently in an unstructured environment.
• Interpersonal savvy, demonstrated by the ability to interact with and influence people to establish trust and build strong relationships.
• Familiar with concepts like Motivational interviewing, trauma informed care and care coordination.
• Ability to complete unscheduled home visits, completed cold-calls and outreach.
• Strong organization skills and ability to manage and maintain a personal schedule.
• Proficient in time management and the ability to prioritize tasks effectively. 
• Ability to work independently within a field-based environment and as part of a team.
• Excellent communication and motivational interviewing skills to engage with difficult patients and the ability to explain technical medical information. 
• Proficient in the accurate and timely documentation of patient information in multiple electronic medical record (EMR) systems to ensure seamless continuity of care and data integrity. 

QUALIFICATIONS:

• At least 2 years of relevant work experience as a Community Health Worker, Peer Support Specialist, Medical Assistant, or similar role
• High school graduate or GED required.
• A valid driver’s license and auto liability insurance.
• Reliable transportation and the ability to travel within your assigned territory or other as needed to support the patient needs plan and training requirements.
• Experience in Chronic Care Management model OR experience with chronically ill/elderly patients.
• Long-time resident of the community with good knowledge of the resources of this community.
• Ability to complete Upward Health’s initial training program and ongoing educational requirements as assigned, both virtually and in-person. 
• Technologically savvy with basic computer skills, including ability to type.
• Multi-lingual capabilities preferred, but not required.
• Prior Home Care experience a plus

Upward Health is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. 

This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. 

Compensation details: 24-27 Yearly Salary

PI5bdef9dbc100-34600-36953225

Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description:

The Care Specialist - ECM is responsible for coordinating care for high-complexity patients, mainly working in the field to provide chronic care coordination and support. This role involves direct outreach to patients through phone calls, home visits, and community interactions. The Care Specialist primarily works in patients' homes and communities (90% of the time) and engages in virtual or telephonic support (10% of the time) The Care Specialist will assess patient needs, help set health goals, and ensure that patients receive the appropriate care and resources, with a focus on increasing access to preventative care, reducing emergency room visits, and enhancing self-management. The role requires excellent communication skills, critical thinking, and the ability to work independently and adapt to evolving challenges.

Skills Required:

• At least 2 years of relevant work experience as a Community Health Worker, Peer Support Specialist, Medical Assistant, or in a similar role.
• High school diploma or GED required.
• A valid driver’s license and auto liability insurance.
• Reliable transportation and the ability to travel within assigned territory or as needed.
• Experience in care coordination for individuals with chronic conditions, behavioral health conditions, or with  patients experiencing housing insecurities including homelessness.
• Strong interpersonal and motivational interviewing skills to build trust and rapport with patients.
• Familiarity with trauma-informed care, care coordination, and patient education.
• Proficiency in the use of electronic medical records (EMR) systems and basic computer skills.
• Technologically savvy and able to manage documentation and data entry effectively.
• Ability to work independently in a field-based environment and as part of a team.
• Multi-lingual capabilities preferred but not required.
• Prior home care or Enhanced Care Management experience a plus.
• Community Health Worker certification is a plus.

Key Behaviors:

Adaptability: 

• Ability to work in dynamic, unstructured environments, pivoting quickly to meet the needs of patients and the organization.

Critical Thinking & Problem Solving: 

• Demonstrates strong problem-solving skills when assessing patient needs and determining the best course of action.

Motivational Interviewing & Empathy: 

• Uses motivational interviewing techniques to build rapport, set health goals, and empower patients to take charge of their care.

Relationship Building: 

• Skilled in establishing trust and fostering strong relationships with patients, families, and team members.

Self-Starter: 

• Takes initiative to perform outreach, complete assessments, and follow through with care coordination independently.

Organizational Skills: 

• Excellent at managing time, tasks, and schedules, ensuring that all patient needs are addressed in a timely manner.

Resilience: 

• Demonstrates resilience in challenging situations and remains focused on the goal of improving patient outcomes despite setbacks.

Cultural Competence: 

• Demonstrates sensitivity to and understanding of diverse cultural backgrounds, ensuring that care is provided in a culturally inclusive manner.

Commitment to Quality Care: 

• Shows passion for delivering high-quality care and support to patients, ensuring their well-being and satisfaction.

Competencies:

Care Coordination: 

• Ability to assess patient needs, coordinate care with interdisciplinary teams, and ensure patients are receiving the appropriate services.

Patient Advocacy: 

• Supports patients by navigating healthcare systems, advocating for needed resources, and ensuring timely access to care.

Health Education & Communication: 

• Educates patients about their health conditions, treatments, and the healthcare system in a clear and empathetic manner.

Data Management & Reporting: 

• Proficient in documenting patient interactions and maintaining accurate, up-to-date records in EMR systems.

Patient Outreach & Engagement: 

• Proactively reaches out to patients through multiple communication channels, including phone, in-person visits, and community outreach.

Goal Setting & Self-Management: 

• Works with patients to develop self-care plans, emphasizing shared decision-making and increasing the patient’s ability to manage their own health.

Collaboration & Teamwork: 

• Works effectively as part of an interdisciplinary care team to achieve organizational goals and improve patient outcomes.

Crisis Management & Flexibility: 

• Demonstrates flexibility and adaptability in managing unforeseen challenges, providing support where it is needed most.

Technical Proficiency: 

• Skilled in using healthcare software applications and systems for accurate data entry and patient management.

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.

Compensation details: 24-27 Hourly Wage

PI3b7ff222cdd8-34600-37431746

Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description:

The Care Specialist  role for the Justice-Involved Enhanced Care Management  program (JI ECM) is responsible for coordinating care for high-complexity patients, mainly working in the field to provide ongoing care coordination and support. This role involves direct outreach to patients through phone calls, home visits, visits within places of confinement, and community interactions. The Care Specialist primarily works in patients' homes and communities (90% of the time) and engages in virtual or telephonic support (10% of the time). The Care Specialist will assess patient needs, help set health goals and ensure that patients receive the appropriate care and resources, with a focus on increasing access to preventative care, reducing emergency room visits, and enhancing self-management. 

Additionally, this role requires specialized support for justice-involved individuals, including those transitioning out of jail or prison. The Care Specialist will work closely with correctional facilities, reentry programs, and community-based organizations to facilitate smooth transitions, address health disparities, and connect individuals to critical health and social services as part of California's CalAIM initiatives. The role demands strong advocacy skills, cultural competence, and a deep understanding of the barriers faced by justice-involved populations. The Care Specialist will play a vital role in improving health outcomes and reducing recidivism by addressing both medical and social determinants of health.

Skills Required:

• At least 2 years of relevant work experience as a Community Health Worker, Peer Support Specialist, Medical Assistant, or in a similar role.
• High school diploma or GED required.
• A valid driver’s license and auto liability insurance.
• Reliable transportation and the ability to travel within assigned territory or as needed.
• Experience in care coordination for individuals with chronic conditions, behavioral health conditions, or with patients experiencing housing insecurities including homelessness.
• Experience supporting justice-involved populations, particularly individuals transitioning out of jail or prison, in alignment with California’s CalAIM initiatives.
• Strong interpersonal and motivational interviewing skills to build trust and rapport with patients.
• Familiarity with trauma-informed care, care coordination, and patient education.
• Proficiency in the use of electronic medical records (EMR) systems and basic computer skills.
• Technologically savvy and able to manage documentation and data entry effectively.
• Ability to work independently in a field-based environment and as part of a team.
• Multi-lingual capabilities preferred but not required.
• Prior home care or Enhanced Care Management experience a plus.
• Community Health Worker certification is a plus.

Key Behaviors:

Adaptability: 

• Ability to work in dynamic, unstructured environments, pivoting quickly to meet the needs of patients and the organization.

Critical Thinking & Problem Solving: 

• Demonstrates strong problem-solving skills when assessing patient needs and determining the best course of action.

Motivational Interviewing & Empathy: 

• Uses motivational interviewing techniques to build rapport, set health goals, and empower patients to take charge of their care.

Relationship Building: 

• Skilled in establishing trust and fostering strong relationships with patients, families, and team members.

Self-Starter: 

• Takes initiative to perform outreach, complete assessments, and follow through with care coordination independently.

Organizational Skills: 

• Excellent at managing time, tasks, and schedules, ensuring that all patient needs are addressed in a timely manner.

Resilience: 

• Demonstrates resilience in challenging situations and remains focused on the goal of improving patient outcomes despite setbacks.

Cultural Competence: 

• Demonstrates sensitivity to and understanding of diverse cultural backgrounds, ensuring that care is provided in a culturally inclusive manner.

Commitment to Quality Care: 

• Shows passion for delivering high-quality care and support to patients, ensuring their well-being and satisfaction.

Competencies:

Care Coordination: 

• Ability to assess patient needs, coordinate care with interdisciplinary teams, and ensure patients are receiving the appropriate services.

Patient Advocacy: 

• Supports patients by navigating healthcare systems, advocating for needed resources, and ensuring timely access to care.

Health Education & Communication: 

• Educates patients about their health conditions, treatments, and the healthcare system in a clear and empathetic manner.

Data Management & Reporting: 

• Proficient in documenting patient interactions and maintaining accurate, up-to-date records in EMR systems.

Patient Outreach & Engagement: 

• Proactively reaches out to patients through multiple communication channels, including phone, in-person visits, and community outreach.

Goal Setting & Self-Management: 

• Works with patients to develop self-care plans, emphasizing shared decision-making and increasing the patient’s ability to manage their own health.

Collaboration & Teamwork: 

• Works effectively as part of an interdisciplinary care team to achieve organizational goals and improve patient outcomes.

Crisis Management & Flexibility: 

• Demonstrates flexibility and adaptability in managing unforeseen challenges, providing support where it is needed most.

Technical Proficiency: 

• Skilled in using healthcare software applications and systems for accurate data entry and patient management.

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.

Compensation details: 24-27 Hourly Wage

PIf1c1d2bbf801-34600-38079205

Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description:

The Care Navigator serves as the primary point of contact for patients, ensuring a seamless and coordinated care experience. They will be responsible for facilitating communication between patients, their families, providers, and the Care Team, ensuring the delivery of comprehensive and continuous care. The Care Navigator will also handle patient registration, insurance verification, scheduling, follow-up support after visits, and offer general administrative assistance. This role is essential in optimizing patient care by coordinating with multiple healthcare providers, verifying insurance coverage, and supporting the broader Care Team to ensure smooth transitions and ongoing care.

Skills Required:

• 3+ years of experience in a healthcare practice, preferably in a patient representative or care coordination role
• High school diploma or GED required
• Experience with health insurance, including verification and understanding of medical terminology
• Strong organizational skills with the ability to handle multiple tasks in a fast-paced environment
• Excellent oral and written communication skills for clear and efficient communication with patients, providers, and the Care Team
• Strong attention to detail to ensure that all information is accurate and comprehensive
• Technologically savvy, including proficiency with EHR and related systems
• Ability to work independently in a remote setting while collaborating effectively with team members
• Multilingual capabilities preferred, but not required
• Knowledge of community resources in the applicable geographic area

Key Behaviors:

Patient-Centered Focus:

• Ensures patients receive the support and resources they need by acting as the main point of contact and providing ongoing communication to help them navigate the healthcare system.

Adaptability & Flexibility:

• Demonstrates the ability to change course and take on new tasks as needed, thriving in a fast-paced environment and responding to evolving patient needs.

Urgency & Proactive Action:

• Works with a sense of urgency to ensure all administrative, clinical, and coordination tasks are completed promptly, helping to expedite the delivery of care for patients.

Team Collaboration:

• Works cohesively with the Care Team, providers, and other stakeholders to ensure smooth care delivery and address patient needs effectively.

Strong Communication Skills:

• Utilizes clear, empathetic, and professional communication with patients, their families, and healthcare providers to ensure all needs are addressed and met.

Attention to Detail:

• Ensures all documentation and patient information is accurate, complete, and updated in a timely manner.

Competencies:

Care Coordination & Patient Advocacy:

• Demonstrated ability to facilitate the coordination of care across multiple providers and service levels, ensuring continuity and timeliness of patient care.

Insurance & Billing Knowledge:

• Experience in verifying insurance information, handling prior authorizations, and addressing insurance inquiries to ensure patients are covered and have access to necessary services.

Data Entry & Technology Proficiency:

• Ability to accurately enter data and navigate multiple healthcare technology systems, including EHRs and CRM platforms, to maintain organized and up-to-date patient records.

Problem-Solving & Critical Thinking:

• Ability to identify and resolve issues that may arise in patient care coordination, such as insurance eligibility, scheduling conflicts, or resource gaps.

Multitasking & Time Management:

• Capable of managing various tasks, such as scheduling appointments, patient follow-ups, and handling insurance inquiries, while maintaining attention to detail and deadlines.

Cultural Competency & Empathy:

• Ability to effectively engage with patients from diverse backgrounds, demonstrating cultural sensitivity and empathy to meet their individual needs.

Professional Boundaries & Confidentiality:

• Maintains appropriate professional boundaries with patients and team members while ensuring patient privacy and confidentiality in all interactions.

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.

Compensation details: 18-24 Yearly Salary

PI127e9d84652e-34600-38156076

Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description:

The Care Specialist is a key member of the team responsible for delivering chronic care management to high-complexity patients. The Care Specialist primarily works in patients' homes and communities (90% of the time) and engages in virtual care (10% of the time). This role involves direct outreach to patients, guiding them through the enrollment process, facilitating virtual appointments with providers, and ensuring that patients adhere to care plans. By building relationships, coordinating care, and providing education, the Care Specialist plays a critical role in promoting health, preventing unnecessary hospitalizations, and improving patient outcomes.

Skills Required:

• Minimum of 2 years of relevant work experience (e.g., Community Health Worker, Peer Support Specialist, Medical Assistant, etc.).
• High school diploma or GED required.
• A valid driver’s license, auto liability insurance, and reliable transportation to travel within the assigned territory.
• Experience in chronic care management or working with chronically ill/elderly patients.
• Technologically proficient with basic computer skills (typing, using EMR systems).
• Experience with motivational interviewing, trauma-informed care, and care coordination.
• Strong interpersonal communication skills with the ability to engage patients and team members effectively.
• Ability to prioritize tasks, manage schedules, and work independently in an unstructured environment.
• Multi-lingual skills are a plus but not required.
• Prior home care experience is beneficial.

Key Behaviors:

Adaptability & Resilience: 

• Ability to thrive in unstructured environments and pivot as needed to meet patient needs. Demonstrates perseverance in challenging situations.

Self-Starter & Motivation: 

• Proactively takes initiative in managing patient care and outreach. Willingness to learn and adapt to new processes and systems.

Empathy & Compassion: 

• Ability to work with individuals from diverse backgrounds and understand their complex needs. Skilled in building rapport through motivational interviewing and other patient-centered communication techniques.

Accountability & Integrity: 

• Demonstrates personal responsibility and takes ownership of tasks, ensuring accuracy and timeliness in all activities.

Cultural Competence: 

• Awareness of community dynamics and diversity, ensuring culturally sensitive and inclusive care.

Team Collaboration: 

• Works collaboratively with interdisciplinary teams to meet patient and organizational goals.

Problem-Solving & Critical Thinking: 

• Strong critical thinking skills to assess patient needs, analyze data, and develop appropriate care strategies.

Communication Skills: 

• Excellent verbal and written communication, capable of explaining complex medical information to patients in a clear and supportive manner.

Competencies:

Care Coordination: 

• Ability to engage patients in a comprehensive care plan, facilitating communication between patients, providers, and family members to ensure timely, effective care.

Health Education: 

• Effectively educates patients about their medical conditions, care plans, and available resources, ensuring that patients can make informed decisions.

Patient Engagement: 

• Uses various strategies, including phone calls, home visits, and community outreach, to engage patients and ensure continuous participation in their care.

Time Management & Organization: 

• Demonstrates strong organizational skills by managing patient caseloads, schedules, and documentation efficiently.

Technology Proficiency: 

• Skilled in using electronic health records (EMR) systems and other digital tools to document patient information and communicate within the team.

Motivational Interviewing & Patient-Centered Care: 

• Uses motivational interviewing techniques to build rapport and empower patients to take ownership of their health decisions.

Data Management: 

• Ensures accurate and timely documentation of patient data, ensuring continuity of care and compliance with organizational standards.

Outcome-Oriented Approach: 

• Focuses on achieving key health outcomes, such as improved care adherence, reduction in emergency room visits, and enhanced self-management.

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.

Compensation details: 21-24 Hourly Wage

PIea161711e1d3-34600-37829331