Primary Care Engagement Care Manager

Wheeler•Plainville, CT

1d•$22

About The Position

The Primary Care Engagement Care Manager is responsible for ensuring that patients entering the organization through behavioral health and psychiatric services are successfully connected to, seen by, and retained within primary care. This role provides proactive outreach, care coordination, and follow-up to support timely primary care engagement, visit completion, and continuity of care. In addition to direct care management responsibilities, this role plays a key role in the development, training, and optimization of an AI-enabled care engagement model designed to support primary care connection and patient outreach. The incumbent will translate real-world care coordination workflows into scalable, AI-supported processes, including training, validating, and refining AI-driven patient interactions. This position is designed to evolve over time; following successful implementation and stabilization of the AI-enabled model, the role will transition into a standard Care Management position with an assigned patient panel.

Requirements

1 year of related experience or a High School Diploma/GED and 5 years related experience.
Exhibits strong interpersonal, critical thinking and problem-solving skills.
Good written and communication skills.
Excels in efficiency and time management skills.
Maintains a calm demeanor and practices active listening skills.
Ability to provide empathy and compassion to population served.
Demonstrates proficiency in Microsoft Office applications and other software programs.

Nice To Haves

Case management experience in a health care setting is preferred.
Knowledge of Connecticut community resources and organizations.
Spanish speaking is preferred.

Responsibilities

Provides outreach to patients identified through behavioral health and psychiatric services who do not have an established primary care provider and supports development of person-centered care plans.
Coordinates and facilitates timely connection to primary care services, including managing behavioral health to primary care (BH to PCP) conversion, appointment scheduling and ensuring visit completion.
Supports the design, implementation, training, and optimization of technology-enabled workflows, including AI-supported outreach tools, by translating care coordination activities into scalable processes and reviewing AI-generated communications for accuracy, appropriateness, and tone.
Monitors AI-supported patient interactions, identifies gaps, risks, and escalation scenarios, and provides feedback to improve performance, safety, and patient experience.
Partners with clinical, operational, and technology teams to test, validate, and refine AI-driven outreach and engagement strategies to ensure alignment with clinical standards and organizational goals.
Tracks primary care appointments, conducts outreach following missed visits and key care events, and implements reminder and no-show workflows to promote continuity of care.
Collaborates with interdisciplinary care team members, including behavioral health clinicians, primary care providers, and support staff, to coordinate care, ensure closed-loop communication, and address barriers impacting outcomes.
Supports continuity of care by utilizing available systems and reports to monitor patient engagement, track activity and outcomes, identify gaps in care, and initiate follow-up as needed.
Supports patients in navigating the healthcare system by facilitating access to services, addressing social determinants of health, and promoting engagement in preventive care, chronic disease management, and regular primary care follow-up.
Connects patients to appropriate internal programs, community resources, and referral pathways based on identified needs.
Documents all care coordination activities in the electronic health record in a timely, accurate, and compliant manner.
Identifies escalation needs and facilitates appropriate handoffs to clinical or supervisory staff.
Participates in quality improvement initiatives to enhance access, engagement, and care outcomes.
Demonstrates cultural humility and continues to develop knowledge of the diverse backgrounds, values, and needs of the populations served, incorporating culturally responsive approaches into care coordination.
Understands and adheres to Wheeler Clinic’s compliance standards as they appear in the clinic’s Corporate Compliance Plan, Code of Conduct, and Conflict of Interest Policy.
Completes all training in a timely manner as required by state and federal regulations (e.g., Compliance, Fire Safety, HIPAA HITECH, Infection Control, Sexual Harassment, etc.) and specific to the department and position.
Keeps abreast of all pertinent federal, state and clinic regulations, laws, and policies as they presently exist and as they change or are modified.
Performs other related duties as assigned.

Benefits

Comprehensive medical and prescription insurance through Centivo
Comprehensive dental and vision insurance through Cigna
Access to wellness programs to support your physical and mental health
Enjoy peace of mind with company-paid life and AD&D insurance
403(b) Plan, with contributions from the company
Pursue your educational goals with our Education Reimbursement Program
Access training and development opportunities
Receive a productivity incentive to recognize your hard work and dedication
Recharge with generous paid time off, including:
15 vacation days per year to explore and recharge
8 sick days per year for your well-being
2 personal days per year for your personal needs
2 floating holidays per year to celebrate what matters to you
9 paid company holidays to spend with loved ones
Access free and confidential counseling through our Employee Assistance Program (EAP)