Deliver personalized care management and coordination services Conduct patient assessments and develop individualized care plans Support chronic disease management (e.g., diabetes, hypertension, CHF, COPD) Provide education on disease states, medications, and self-management strategies Utilize motivational interviewing techniques to enhance adherence and engagement Collaborate with providers and care teams to align treatment plans Identify care gaps, risks, and barriers to optimal outcomes Maintain accurate, compliant, and timely documentation Support care transitions and follow-up coordination. Strong clinical judgment and attention to detail Excellent communication and interpersonal skills Ability to build rapport and trust in a remote setting Patient-centered, outcomes-driven mindset Self-motivated and able to work independently High level of professionalism and accountability.