Bilingual Integrated Care Coach

About the role

Become a part of our caring community. The Care Coach provides proactive, patient‑centered care coordination and social needs support for the highest‑risk top 5% patient membership. You will serve as the primary contact for patients, focusing on care coordination, adherence coaching, healthcare navigation, transitions of care, and reinforcing care plans. You will report to a Care Integration Team Manager within the CenterWell and Conviva Primary Care organization.

Responsibilities

• Clinical Screening & Escalation: Conduct structured patient interviews and collect health‑related information (e.g., medication regimen and barriers to adherence, social barriers, functional status); document and share findings with providers.
• Outreach and Home