Helping others achieve better health is the core mission of this Health Coach role, which supports patient health outcomes through proactive outreach, education, and care coordination. The incumbent engages patients primarily by telephone to facilitate transitions of care, coordinate preventive appointments, support medication adherence, and identify barriers to accessing care.
Responsibilities
Conduct proactive telephonic outreach to patients to support engagement in recommended healthcare services, preventive care, and follow-up activities
Facilitate Transitional Care Management (TCM) outreach following hospital discharges or other qualifying healthcare events, coordinating timely follow-up appointments and communication between patients and their healthcare providers
Support efforts to reduce avoidable hospital readmissions by reinforcing discharge instructions, identifying potential barriers to follow-up care, and connecting patients with appropriate clinical or operational resources
Contact patients to schedule Annual Wellness Visits and other recommended preventive care appointments in accordance with established outreach protocols
Conduct Social Determinants of Health (SDOH) surveys to identify potential barriers to care, including transportation, food insecurity, housing instability, and other nonmedical needs, and refer identified concerns to appropriate resources or internal teams
Support medication adherence by contacting patients to confirm prescription fills, identifying potential access barriers, and coordinating with pharmacies, providers, or internal teams as appropriate
Educate patients on available healthcare benefits, resources, and services to encourage appropriate utilization and ongoing engagement in their care
Document patient outreach, appointment coordination, identified barriers, and follow-up activities accurately and timely within designated systems
Collaborate with clinical and operational teams to escalate patient concerns, coordinate outstanding follow-up needs, and support continuity of care
Maintain patient confidentiality and comply with HIPAA, organizational policies, and established care coordination protocols
Perform additional duties as assigned
Requirements
High school diploma or equivalent required
Associate's or bachelor's degree in healthcare, health promotion, public health, psychology, or a related field preferred
1+ year of experience in healthcare, patient outreach, care coordination, health coaching, customer service, or a related field preferred
Familiarity with healthcare operations, preventive care, Transitional Care Management (TCM), medication adherence, and Social Determinants of Health (SDOH) preferred
Strong interpersonal and patient engagement skills, with the ability to establish rapport, demonstrate empathy, and communicate effectively with diverse patient populations
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Excellent verbal and written communication skills, particularly in conducting telephonic outreach, explaining healthcare information, and coordinating with patients and providers
Strong organizational and time-management skills, with the ability to manage multiple patient outreach activities, prioritize follow-up needs, and maintain accurate documentation
Strong critical thinking and problem-solving skills, with the ability to identify barriers to care, determine appropriate next steps, and escalate concerns in accordance with established protocols
Ability to work independently while collaborating effectively with clinical, operational, and other cross-functional teams
Proficiency with Google Workspace (Drive, Docs, Sheets, Slides) and the ability to navigate electronic medical records, patient management systems, and other healthcare technology
Strong attention to detail, accountability, and commitment to completing assigned outreach and follow-up activities accurately and timely
Demonstrated ability to maintain confidentiality and handle protected health information in accordance with HIPAA and organizational policies
Appreciation of cultural diversity and sensitivity toward the patient populations served
Important Details
Reports To: Manager, Operations
About the Company
Better Health Group is committed to helping others achieve better health, supporting providers and payors to deliver best-in-class healthcare experiences for patients.
