Integrated Care Coach

About the role

The Care Coach is the primary contact for the highest‑risk (top 5%) senior members, delivering patient‑centered care coordination, adherence coaching, navigation and transition support, and acting as a liaison among patients, providers and community resources within the CenterWell/Conviva Primary Care team.

About the company

Conviva Senior Primary Care, part of Humana's Primary Care Organization and the CenterWell brand, provides proactive, value‑based primary care for seniors that integrates medical, social, emotional and financial wellness, leveraging a large senior‑focused network that includes primary care, home health and pharmacy services.

Requirements

• Healthcare professional with at least 3 years experience in ambulatory, primary care, or senior‑care direct patient care
• Bilingual English/Spanish (read, write, speak)
• Ability to discuss chronic conditions and reinforce medication instructions
• Comfortable conducting regular home visits and community outreach
• Demonstrated experience in patient education, care coordination, and social support for high‑risk or geriatric populations
• Active unrestricted LPN/LVN license or MA certification, or equivalent foreign RN/Physician license (preferred)
• Experience in care coordination, case management, population health or value‑based care models (preferred)
• Experience conducting post‑hospital/ED follow‑up with appropriate escalation (preferred)
• Familiarity with Medicaid, long‑term care and HCBS programs (preferred)
• Experience working with seniors and medically complex populations (preferred)
• Prior home‑visit experience and knowledge of field safety practices (preferred)
• Valid state driver’s license and personal vehicle liability insurance meeting required limits
• Must pass Humana TB screening program