Care Specialist - Enhanced Care Management

Upward Health • San Francisco, CA

2d • $24 - $27

About The Position

The Care Specialist - Enhanced Care Management coordinates care for high-complexity patients, primarily in the field, providing chronic care coordination and support. The role involves direct patient outreach through phone calls, home visits, and community interactions. Work is conducted mainly in patients’ homes and communities (90% of the time), with virtual or telephonic support accounting for the other 10%.

The Care Specialist assesses patient needs, helps establish health goals, and ensures patients receive appropriate care and resources. The position focuses on increasing access to preventative care, reducing emergency room visits, and improving patients’ ability to manage their health. It requires strong communication and critical-thinking skills, independence, and adaptability.

Requirements

• At least 2 years of relevant work experience as a Community Health Worker, Peer Support Specialist, Medical Assistant, or in a similar role.
• At least 2 years of pediatric experience involving community referrals, care coordination, navigation of healthcare providers and services, or management of healthcare support resources.
• High school diploma or GED.
• Valid driver’s license and auto liability insurance.
• Reliable transportation and ability to travel within an assigned territory or as needed.
• Experience coordinating care for individuals with chronic conditions, behavioral health conditions, or housing insecurity, including homelessness.
• Strong interpersonal and motivational interviewing skills to build trust and rapport with patients.
• Familiarity with trauma-informed care, care coordination, and patient education.
• Proficiency with electronic medical record systems and basic computer skills.
• Technological skills to manage documentation and data entry effectively.
• Ability to work independently in a field-based environment and as part of a team.

Nice To Haves

• Multilingual capabilities.
• Prior home care or Enhanced Care Management experience.
• Community Health Worker certification.

Responsibilities

• Coordinate care and provide chronic care support for high-complexity patients.
• Reach patients through phone calls, home visits, and community interactions.
• Assess patient needs and help patients establish health goals.
• Coordinate appropriate care and connect patients with relevant resources and services.
• Support access to preventative care, reduce avoidable emergency room visits, and promote patient self-management.
• Document patient interactions and maintain accurate records in electronic medical record systems.
• Educate patients about health conditions, treatments, and the healthcare system.
• Advocate for patients navigating healthcare systems and seeking needed resources.
• Collaborate with interdisciplinary care teams.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED