Why Vitasora Health
Vitasora Health is redefining how chronic care is delivered in America. We connect patients, providers, and payers through a technology-driven platform built around RPM, CCM, and telehealth—making proactive, continuous care accessible beyond the clinic. Joining Vitasora means being part of a mission-driven team that is not just responding to the future of healthcare—we are building it. Vitasora Health is an Equal Opportunity Employer (EOE) and does not discriminate based on race, color, religion, gender, sexual orientation, national origin, disability, or veteran status. We are committed to fostering an inclusive and diverse workplace that reflects the communities we serve.
What Vitasora Health Offers
We offer a competitive compensation package including comprehensive medical, vision, and dental coverage, a 401(k) plan, and paid time off. You’ll join a collaborative, high-energy environment where innovation is encouraged, contributions are recognized, and careers grow alongside a company shaping the future of remote care.
Job Description
The Care Coordinator is a clinical cornerstone of Vitasora Health’s remote care team, responsible for managing the ongoing health needs of patients enrolled in Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) programs. This role combines clinical expertise with advanced patient engagement skill, including motivational interviewing and health coaching, to build meaningful and trusting relationships that support lasting behavior change and improved outcomes for patients managing chronic conditions such as cardiovascular disease, diabetes, obesity, and respiratory challenges. Care Coordinators receive warm handoffs of newly enrolled patients and are responsible for delivering a seamless, white glove onboarding experience that sets the tone for the ongoing care relationship. Guided by our values of Empathy First, Relentless Advocacy, Radical Simplicity, and Shared Growth, the Care Coordinator delivers care that goes beyond the clinic.
Core Responsibilities
Patient Engagement and Health Coaching
- Conduct monthly outreach calls with assigned patients using motivational interviewing techniques including open-ended questions, reflective listening, affirmation, and summarizing to foster intrinsic motivation and support self-directed health goals.
- Apply health coaching principles to guide patients through goal-setting, behavior change planning, and accountability, meeting each patient where they are in their readiness to change.
- Develop and regularly update individualized CCM care plans based on comprehensive patient assessments, personal values, and stated health priorities.
- Provide tailored health education and self-management strategies for chronic conditions using plain language and culturally responsive communication.
- Address social determinants of health including economic, environmental, and social barriers that impact patient engagement and care access, particularly in rural and underserved communities.
Patient Onboarding
- Receive warm handoffs of newly enrolled patients from the enrollment team and deliver a seamless, white glove onboarding experience that establishes trust and sets the foundation for the ongoing care relationship.
- Complete baseline assessments covering health history, medications, social determinants, and patient goals to inform initial care plan development.
- Use motivational interviewing during onboarding conversations to build rapport, assess readiness, and establish early engagement.
- Partner with billing, clinical leadership, and referring providers to ensure accurate onboarding and seamless EHR setup.
Care Coordination and Interdisciplinary Collaboration
- Serve as the connective thread between patients and their broader care teams, facilitating warm handoffs and timely communication with physicians, nurses, social workers, and specialists.
- Monitor patient progress through remote monitoring data and regular touchpoints and escalate clinical concerns to appropriate providers using structured communication protocols.
- Collaborate with interdisciplinary teams to co-develop care strategies, align on shared goals, and optimize patient outcomes across the care continuum.
- Participate in team huddles and case reviews to stay aligned on program priorities and share insights from patient interactions.
Clinical Documentation and Compliance
- Maintain accurate, timely, and HIPAA-compliant documentation of all patient interactions, care plans, and clinical observations in the Electronic Health Record system.
- Ensure adherence to CMS guidelines for Chronic Care Management services, NCQA standards, Joint Commission requirements, and applicable regulations.
- Track patient engagement metrics, document motivational interviewing and health coaching outcomes, and contribute to reporting on program performance and patient progress.
- Identify patterns in patient barriers and recommend workflow or care plan improvements to the clinical leadership team.
Patient Advocacy and Support
- Identify and proactively address barriers to care access, connecting patients with community resources, healthcare services, and support networks.
- Promote culturally competent, patient-centered care that honors the unique values, preferences, and lived experiences of each individual served.
- Champion the patient’s voice within the care team, ensuring their goals and concerns are heard, respected, and incorporated into clinical decision-making.
This role may require completion of tasks and responsibilities outside of those listed above as business needs evolve. Flexibility and a willingness to contribute beyond defined expectations is an important part of this role.
Required Qualifications
- Must hold at least one of the following, current and in good standing:
CMA (AAMA) — NCCA-accredited
CCMA (NHA) — NCCA-accredited
NCMA (NCCT) — NCCA-accredited
CMAC (AMCA) — NCCA-accredited
RMA (AMT) — NCCA-accredited
Active, unencumbered RN or LPN/LVN Compact license
- All certifications and licenses must be current and in good standing, and will be verified through primary source before hire.
- Minimum 1 year of clinical experience in chronic care management, telehealth, primary care, or a related setting; 3 or more years preferred.
- Demonstrated knowledge of and experience applying motivational interviewing and health coaching techniques in a clinical or patient engagement setting.
- Proficiency in EHR systems, telehealth platforms, and remote patient monitoring tools.
- Strong verbal and written communication skills with the ability to engage patients empathetically, navigate objections, and promote behavior change.
- Familiarity with CMS CCM guidelines, HIPAA regulations, NCQA standards, and applicable compliance requirements.
Preferred Qualifications
- Bilingual proficiency in English and Spanish. Additional languages welcome.
- Experience working with Medicare and Medicaid patients and managing complex chronic disease populations.
- Knowledge of social determinants of health and their impact on rural and underserved communities.
- Prior experience in telehealth, RPM, or other virtual care delivery models.
- Proven ability to build rapport quickly and handle sensitive conversations with empathy and professionalism.
Core Competencies
- Motivational Interviewing & Behavior Change Support
- Health Coaching & Patient Goal-Setting
- Patient-Centered Communication & Active Listening
- Chronic Care Management & Clinical Documentation
- Healthcare Compliance & HIPAA Awareness
- Interdisciplinary Collaboration & Care Coordination
- EHR, Telehealth & Remote Monitoring Technology
Compensation
- $18.00 to $28.00 per hour
Schedule, Availability, and Location
- 8:00 AM – 4:30 PM EST Monday to Friday
- 9:00 AM – 5:30 PM EST Monday to Friday
- 12:00 PM – 8:30 PM EST Monday to Friday
- This role is fully remote and open to candidates residing in the following states: AL, AZ, AR, CA, CT, DE, FL, GA, HI, IL, IN, KY, LA, MA, MI, MN, MS, NE, NV, NH, NJ, NM, NY, NC, OH, OR, TN, TX, W
This role requires flexibility in scheduling based on business needs, which will be communicated well in advance. Team members may be asked to adjust working hours, including early mornings, evenings, or occasional weekends, to support patient outreach goals, program deadlines, or operational demands. A willingness to work flexible hours is an important part of this role.
Physical & Remote Work Requirements
- Prolonged periods of sitting and working on a computer.
- Reliable high-speed internet (minimum 50 Mbps) and quiet, distraction-free workspace.
- Must be able to lift up to 15 pounds at times.
Our Mission & Vision
Our Mission: Giving doctors a complete view with care that’s always on. Vitasora expands the capacity of healthcare practitioners to give exceptional care by providing insights beyond the limitations of the clinic, no matter where patients are.
Our Vision: A world where care never stops. A world where living with a chronic condition no longer means navigating it alone — where every patient has a care-keeper by their side and every clinician is empowered to extend their reach beyond the exam room.
Vitasora Health USA Inc is an Equal Opportunity Employer (EOE) and does not discriminate based on race, color, religion, gender, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by applicable federal, state, or local law, including but not limited to gender identity, gender expression, marital status, medical condition, genetic information, ancestry, and age. We are committed to fostering an inclusive and diverse workplace that reflects the communities we serve.
Pay: $18.00 - $30.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Opportunities for advancement
- Paid time off
- Paid training
- Referral program
- Vision insurance
Application Question(s):
- Do you reside in one of the following states: AL, AZ, AR, CA, CT, DE, FL, GA, HI, IL, IN, KY, LA, MA, MI, MN, MS, NE, NV, NH, NJ, NM, NY, NC, OH, OR, TN, TX, WV?
- How many years experience do you have in chronic care management?*
- How many years experience do you have in remote patient monitoring?
- How many years experience do you have in telehealth?
- Do you have experience applying motivational interviewing and/or patient activation techniques during patient care?
- Do you have at least one year working experience in a remote environment?
- What are your hourly pay expectations for this role?
- Are you bi-lingual?
- How did you hear about this opportunity? (LinkedIn, Indeed, Referral, Other) If referral, please include the name of the person who referred you. If other, please specify.
- Do you hold an NCCA-accredited MA certification (CMA-AAMA, CCMA-NHA, NCMA-NCCT, CMAC-AMCA, RMA-AMT), or an active, unencumbered RN or LPN/LVN compact license? This is verified during the interview process.
Work Location: Remote
