Ambulatory Care, Artificial Intelligence (AI), Billing, Cardiology, Case Management, Certified Nursing Assistant (CNA), Clinical Assessment, Communication Skills, Congestive Heart Failure, Content Management Systems (CMS), Documentation, Documentation Standards, EMT-Paramedics, Electrocardiogram, Emergency Response, English Language, Establish Priorities, Health Plan, Healthcare, Home Care, Medical Assistance, Medical Billing, Medical Diagnosis, Medical Record System, Medications, Multilingual, Patient Care, Patient Education, Presentation/Verbal Skills, Reconciliation, Registered Nurse (RN), Reporting Dashboards, Risk, Spanish Language, Transitional Care
REMOTE CARE NAVIGATOR – CARDIAC
Sector
Healthcare — Cardiac Care Coordination
Reports To
RN Care Manager / Clinical Supervisor
Type
Full-Time · 40 hours/week
Schedule
Monday–Friday · Weekends - Flexible business hours (US hours, CST/PST overlap required)
Rate
$21–$24 USD/hour (based on experience)
Contract
W-2
Location
100% Remote — US only (Dallas/Fort Worth area preferred)
Tools
EHR platforms, care management software, population health dashboards, CMS documentation tools
Role Overview
Our client — a cardiac care management MSO — is hiring full-time virtual Care Navigators to support a growing population of medically complex patients with cardiac conditions, primarily congestive heart failure (CHF). This is a non-clinical (non-licensed) role focused on telephonic patient outreach, care plan support, CMS-compliant documentation, and coordination across the care team. The Care Navigator works under the supervision of RN Care Managers, escalating all clinical concerns appropriately. This role plays a critical part in reducing avoidable hospitalizations and supporting patient self-management over the long term.
Key Responsibilities
- Conduct structured telephonic outreach to CHF and complex cardiac patients
- Maintain an assigned patient caseload using risk stratification to prioritize outreach
- Complete initial assessments and follow-ups covering symptoms, medications, psychosocial status, and SDOH barriers
- Support Transitional Care Management (TCM) follow-up within 48 hours post-discharge — medication reconciliation, red-flag symptom screening, appointment scheduling
- Provide patient education on CHF self-management and evidence-based strategies
- Monitor for signs of worsening conditions or care gaps and escalate to supervising RN
- Review and act on population health dashboards to address care gaps (wellness visits, labs, symptom monitoring)
- Document time, interventions, care plans, and patient goals per CMS billing standards
- Maintain proactive communication with RN Care Managers, cardiologists, and PCP offices
- Clinical assessment or medical diagnosis
- Medication prescribing or adjustments
- Interpretation of labs, imaging, or EKGs
- Clinical triage or emergency response
- In-person or home visit patient contact
- Billing or coding beyond required time-based documentation
Scope Limitations — This Role Does NOT Include
- Clinical assessment or medical diagnosis
- Medication prescribing or adjustments
- Interpretation of labs, imaging, or EKGs
- Clinical triage or emergency response
- In-person or home visit patient contact
- Billing or coding beyond required time-based documentation
Experience & Skills
Required:
- Active Medical Assistant (MA) certification or equivalent clinical credential (CNA, EMT, CHW with relevant experience)
- Minimum 2 years of experience in care coordination, case management, or ambulatory care
- Familiarity with CMS PCM, CCM, and/or TCM program requirements and documentation standards
- Technologically proficient with care coordination software and/or EHRs
- AI fluency — actively uses AI tools to work faster and more efficiently.
- Must be based in and authorized to work in the United States — time zone compatibility required (US business hours, CST/PST overlap)
- Exceptional written and verbal communication in English; strong phone presence assessed at screening
Preferred:
- Knowledge of cardiac conditions — especially heart failure and associated comorbidities
- Bilingual — Spanish/English (not a must)