CMA Transitional Care Coordinator (Waco, TX)

Ennoble Care • Waco, TX

2d • Onsite

About The Position

Ennoble Care is seeking a full-time Certified Medical Assistant to serve as a Transitional Care Coordinator at one or more partner skilled nursing and rehabilitation facilities in Waco, Texas. This is an on-site, patient-facing role on the clinical care team, working alongside providers in a family-practice-style model focused on continuity, relationship-building, and patient-centered support. The coordinator helps monitor residents, identify and communicate changes in condition, support transitional care management, and help patients avoid unnecessary hospitalizations.

The role serves as a communication link among residents, families, facility staff, Ennoble Care providers, and the Housecalls division. Responsibilities include coordinating care and follow-up after hospital discharge, supporting clinical monitoring and documentation, and collaborating with facility staff to keep care plans current. The position requires a reliable daily presence at assigned facilities and may involve travel between facilities.

The schedule is full-time, on-site, five days per week, with flexible days of the week and weekends preferred. Hours are approximately 8:00 a.m. to 5:00 p.m. CST. There are no evening, overnight, or on-call requirements. Starting pay is $19.00 per hour plus bonus, with quarterly performance-based bonus opportunities and mileage reimbursement eligibility for travel between facilities.

Requirements

• Legally authorized to work in the United States.
• Active, unrestricted Certified Medical Assistant license in Texas.
• At least one year of patient-facing experience in a long-term care, skilled nursing, or transitional care setting.
• Comfort communicating proactively throughout the day in person, by phone, email, and Microsoft Teams.
• Working knowledge of healthcare terminology and care coordination principles.
• Strong clinical assessment skills and ability to identify and escalate changes in condition.
• Experience with EMR systems and clinical documentation.
• Proficiency with Microsoft 365, including Excel, Outlook, Word, and Teams.
• Excellent communication and interpersonal skills, organization, time management, and clinical documentation skills.
• Ability to work independently while collaborating closely with multidisciplinary teams.
• Ability to work full-time on-site five days per week in the Waco, Texas area; days are flexible, and weekends are preferred.
• Ability to pass a background check.
• Valid, unencumbered driver’s license, reliable personally owned vehicle, and current auto insurance with proof available.
• Willingness to travel between facilities when required.

Nice To Haves

• Point Click Care experience preferred.

Responsibilities

• Coordinate care for patients in skilled nursing and rehabilitation facilities using Ennoble Care’s EMR.
• Facilitate transitional care management and ensure Housecalls services are initiated immediately after a patient is discharged from the hospital.
• Expedite the first provider visit for newly transitioned patients according to established guidelines.
• Monitor patients, communicate changes in condition promptly to providers, initiate appropriate interventions, and escalate care as clinically indicated, including CCM-billable activities.
• Support care coordination efforts to reduce avoidable emergency department visits and hospital readmissions.
• Collaborate daily with providers and facility staff to keep care plans current and ensure they are acted on.
• Maintain a consistent daily on-site presence at assigned facilities.
• Build ongoing relationships with residents and their families to support trust and continuity of care.
• Collect routine and urgent vital signs as needed.
• Conduct regular patient check-ins to support care plans, follow-ups, and clinical stability.
• Identify changes in patient condition and promptly communicate concerns to the clinical team.
• Serve as a liaison among Ennoble Care providers, facility staff, residents, families, and the Housecalls team.
• Provide timely, accurate clinical updates to providers to support informed decision-making.
• Convert two eligible patients per day to Ennoble Care’s Housecalls program.
• Accurately document patient interactions, assessments, and care coordination activities in Ennoble Care’s EMR.
• Reconcile charts to support accuracy and continuity between Ennoble Care and facility records.
• Follow established workflows, documentation standards, and escalation protocols.
• Support onboarding and training of new Transitional Care Coordinators and serve as a clinical mentor and resource.
• Promote best practices in transitional care, communication, and facility-based care coordination.
• Contribute to team collaboration and strong partnerships with facility staff.

Benefits

• Seven company-paid holidays annually.
• Quarterly performance-based bonus opportunities.
• Mileage reimbursement eligibility when traveling between facilities.
• Full-time health benefits, including medical, dental, vision, and supplemental insurance options.
• Life insurance and short-term and long-term disability benefits.
• Flexible Spending Accounts for medical and dependent care.
• Accident, critical illness, and hospital indemnity coverage.
• Paid Time Off.
• Paid office holidays.
• Paid sick time.
• 401(k) with up to 3% company match.
• Referral Program.
• Payactiv pay-on-demand access to earned wages.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed