Phamily
Job Title: Clinical Care Coordinator (Remote) – Text-Based APCM Program
Department:
Clinical Operations Location:
Chicago, IL
Position Type:
Full-Time
OVERVIEW Our team is growing!
Jaan Health
is seeking dynamic and motivated Licensed Practical Nurses (LPNs) Clinical Care Coordinators to join our care team and will report to the Clinical Operations Manager. This role requires strong clinical knowledge, adaptability, and the ability to thrive in a fast-paced, patient-centered environment. The LPN will support chronic care management (CCM) and advanced primary care models (APCM) by providing direct patient engagement, care plan support, and clinical triage. This position is remote and offers health benefits as well as a retirement plan and paid days off.
Our company serves 90+ clients who care for over 50,000 patients. We are a rapid-growth B2b SaaS company that offers our clients a software platform called
Phamily
(https://phamily.com/) to provide connected care management to their patients. Phamily keeps patients in contact with their care manager, who regularly checks up on them and acts as a resource for any concerns they might have about their health in order to keep them happier and healthier for longer.
About the Role We are seeking a compassionate, organized, and tech-savvy Clinical Care Coordinator to support patients with chronic conditions in our text-based Advanced Primary Care Management (APCM) program. This remote role focuses on delivering proactive, high-quality care through digital communication tools, driving better health outcomes for Medicare and older adult populations.
This position is ideal for healthcare professionals who thrive in a virtual care setting, value patient engagement, and are skilled in critical thinking and care coordination.
Candidates in other locations may apply, but applications will be held until there are additional resources needed outside of the initial target areas.
Key Responsibilities
Serve as the first line of communication for patients via a secure, text-based platform
Monitor and respond to patient messages and check-ins in a timely, compassionate, and professional manner
Identify, assess, and triage clinical concerns, SDOH needs, and care coordination barriers
Develop and update personalized care plans for patients with chronic conditions (e.g., hypertension, diabetes, COPD)
Develop, implement, and revise care coordination workflows or protocols to support the evolution of the care model to improve efficiency and scalability
Analyze patient data or trends to identify care gaps or improve outcomes
Independently making decisions on patient outreach priorities, resource allocation, or escalation paths
Lead quality improvement initiatives or case review meetings
Serve as a liaison for payer utilization management, interpreting policy, and advising on compliance
Track engagement, log care time, and document all communication per HIPAA and program guidelines
Identify and troubleshoot issues that arise during new program iterations, escalating to leadership when there are critical impacts or opportunities for system-wide improvements
Collaborate with RNs, NPs, and Social Workers to ensure timely escalation and follow-through
Key Skills & Qualifications
2+ years of experience in a clinical or care coordination role (primary care, chronic care management, home health, etc.)
LPN w/ compact license strongly preferred
Strong critical thinking and problem-solving skills in a fast-paced environment
Ability to independently manage a digital patient panel and prioritize escalations effectively
Excellent written communication and documentation skills
Comfort using EMRs, care coordination platforms, and digital messaging tools
Knowledge of Medicare CCM/APCM programs a plus
Bilingual (Spanish) is a bonus but not required
Must be located within the continental United States and have access to reliable internet and ability to work in a specified time zone - either CST, EST, or PST depending on client and candidate location
Access to Internet 5G
Full-time, Monday–Friday
1-hour lunch break, daily huddles with manager/team
Ongoing support from a multidisciplinary care team
Why Join Us?
Mission-driven organization focused on health equity and innovative digital care
Collaborative, diverse, and growth-focused culture
Opportunities for professional development and internal promotion
Competitive compensation and benefits package
Be part of redefining how care is delivered—one text at a time
As set forth in Phamily’s Equal Employment Opportunity policy, we do not discriminate on the basis of any protected group status under any applicable law.
#J-18808-Ljbffr
Clinical Operations Location:
Chicago, IL
Position Type:
Full-Time
OVERVIEW Our team is growing!
Jaan Health
is seeking dynamic and motivated Licensed Practical Nurses (LPNs) Clinical Care Coordinators to join our care team and will report to the Clinical Operations Manager. This role requires strong clinical knowledge, adaptability, and the ability to thrive in a fast-paced, patient-centered environment. The LPN will support chronic care management (CCM) and advanced primary care models (APCM) by providing direct patient engagement, care plan support, and clinical triage. This position is remote and offers health benefits as well as a retirement plan and paid days off.
Our company serves 90+ clients who care for over 50,000 patients. We are a rapid-growth B2b SaaS company that offers our clients a software platform called
Phamily
(https://phamily.com/) to provide connected care management to their patients. Phamily keeps patients in contact with their care manager, who regularly checks up on them and acts as a resource for any concerns they might have about their health in order to keep them happier and healthier for longer.
About the Role We are seeking a compassionate, organized, and tech-savvy Clinical Care Coordinator to support patients with chronic conditions in our text-based Advanced Primary Care Management (APCM) program. This remote role focuses on delivering proactive, high-quality care through digital communication tools, driving better health outcomes for Medicare and older adult populations.
This position is ideal for healthcare professionals who thrive in a virtual care setting, value patient engagement, and are skilled in critical thinking and care coordination.
Candidates in other locations may apply, but applications will be held until there are additional resources needed outside of the initial target areas.
Key Responsibilities
Serve as the first line of communication for patients via a secure, text-based platform
Monitor and respond to patient messages and check-ins in a timely, compassionate, and professional manner
Identify, assess, and triage clinical concerns, SDOH needs, and care coordination barriers
Develop and update personalized care plans for patients with chronic conditions (e.g., hypertension, diabetes, COPD)
Develop, implement, and revise care coordination workflows or protocols to support the evolution of the care model to improve efficiency and scalability
Analyze patient data or trends to identify care gaps or improve outcomes
Independently making decisions on patient outreach priorities, resource allocation, or escalation paths
Lead quality improvement initiatives or case review meetings
Serve as a liaison for payer utilization management, interpreting policy, and advising on compliance
Track engagement, log care time, and document all communication per HIPAA and program guidelines
Identify and troubleshoot issues that arise during new program iterations, escalating to leadership when there are critical impacts or opportunities for system-wide improvements
Collaborate with RNs, NPs, and Social Workers to ensure timely escalation and follow-through
Key Skills & Qualifications
2+ years of experience in a clinical or care coordination role (primary care, chronic care management, home health, etc.)
LPN w/ compact license strongly preferred
Strong critical thinking and problem-solving skills in a fast-paced environment
Ability to independently manage a digital patient panel and prioritize escalations effectively
Excellent written communication and documentation skills
Comfort using EMRs, care coordination platforms, and digital messaging tools
Knowledge of Medicare CCM/APCM programs a plus
Bilingual (Spanish) is a bonus but not required
Must be located within the continental United States and have access to reliable internet and ability to work in a specified time zone - either CST, EST, or PST depending on client and candidate location
Access to Internet 5G
Full-time, Monday–Friday
1-hour lunch break, daily huddles with manager/team
Ongoing support from a multidisciplinary care team
Why Join Us?
Mission-driven organization focused on health equity and innovative digital care
Collaborative, diverse, and growth-focused culture
Opportunities for professional development and internal promotion
Competitive compensation and benefits package
Be part of redefining how care is delivered—one text at a time
As set forth in Phamily’s Equal Employment Opportunity policy, we do not discriminate on the basis of any protected group status under any applicable law.
#J-18808-Ljbffr