LPN Care Coach - Remote

Our Mission:

Circle Link Health® is a company of passionate clinicians, technologists and business people tackling the $600B problem of preventable chronic condition complications. Our mission is to accelerate the shift to preventative care (from status quo reactive care) through our world‑class preventative care platform.

As a Care Coach you will work remotely for 20‑25 hours per week with a team to manage patients with chronic conditions enrolled in Medicare's Chronic Care Management program.

• Educating patients on self‑management skills and goal setting. Chronic conditions include:
  Diabetes, CHF, COPD/Asthma, Hypertension, CAD, Ischemic Heart Disease, Anxiety, Depression, etc.
• Implement and improve the Plan of Care by updating medications, appointments due, recording biometrics, vital signs, and care coaching provided.
• Utilize Motivational Interviewing or other behavior change techniques to coach and assist the patient with self‑management.
• Conduct Transitional Care Management activities to high‑risk patients discharged from the hospital and the ER to reduce unnecessary readmissions, including medication reconciliation, medication adherence, identifying red flags, addressing barriers, encouraging follow‑up care, and guiding when and how to seek appropriate level of care.
• Reduce care gaps by encouraging or assisting with preventive care, and chronic care management (e.g., annual well visits, follow‑up visits, medication management, pre‑visit labs, diagnostic tests due, preventive cancer screens).
• Connect the patient with community resources as needed, including transportation, personal care needs, homemaker or chore services, social services, etc.

• Fluent in English.
• Strong communication skills, self‑directed, able to work independently with little supervision while meeting performance metrics for case completion.
• Strong passion for nursing of Medicare patients.
• All messages and emails from staff must be acknowledged and responded to within 24‑48 hours.
• Caseload will consist of at least 40 patients but could be more.
• Excellent organizational and time‑management skills.
• Strong critical thinking and problem‑solving skills.
• Commitment to work 20‑25 hours, 3 days a week.
• Availability to make calls between 9‑6 pm, EST.
• LPN requires a strong internet‑connected computer. CLHealth does NOT provide computers.

• Current, unrestricted Compact LPN license (please visit  to find your license # and state).
• Proficiency with electronic health records and web‑based applications.
• At least 5+ years' experience as a Licensed Practical Nurse.

• Case Management or Chronic Disease Management experience.
• Case Management Certification.
• Certified Diabetes Educator.
• Transitional Care Management experience.
• Experience with Motivational Interviewing or other behavior change communication techniques.

This is a 1099 contract position with no end date. Care Coaches are responsible for their own taxes, insurance, and computer.

Compensation is paid at the rate of $11.00 per initial clinical encounter per patient per month. A clinical encounter occurs after two criteria are met: a patient has a successful clinical call, and the patient has 20 minutes or more of time in their chart timer. Ex:
If in one hour you called and spoke with 2 patients and spent 20 minutes with each of them, your pay for that hour would be $22.00 ($11.00/pt. reached x
2).

• In addition to successful clinical encounters, Care Coaches shall be entitled to $3.00 in the event that a patient within their caseload withdraws from the Chronic Care Management Program.
• Additionally, a compensation of $4.00 will be paid out following five unsuccessful attempts to contact the patient without receiving a response.

Circle Link is a digital healthcare company that improves health for the chronically ill by engaging patients through personal phone calls and/or mobile technology, helping to solve the $600 billion problem of preventable chronic complications. Our patient engagement software and services enable physicians to monitor and manage their patients' chronic conditions between office visits without investing in additional staff or technology.