About the RoleThis is a rare opportunity to be the first clinical hire and program leader for a growing care navigation program. You'll design, build, and operationalize the infrastructure, workflows, and clinical standards that define how we deliver care at scale - while carrying a limited direct patient caseload during the initial launch phase to inform program design. As you build the program, you'll simultaneously build and lead a multidisciplinary team of advocates, CHWs, LVNs, and other clinical staff.
If you're energized by building systems, leading teams, and driving measurable outcomes in a high-growth environment, this role was written for you.
What You'll DoProgram Leadership & Operations- Design and implement care navigation workflows, SOPs, clinical standards, and program parameters from the ground up
- Lead the hiring for advocates, CHWs, LVNs, and clinical staff by defining role requirements, conducting interviews, and making hiring decisions in coordination with leadership and HR.
- Lead, mentor, and manage performance of a multidisciplinary clinical team
- Conduct performance reviews, coaching, and corrective action as needed
- Define and implement quality improvement processes to drive continuous program enhancement
- Evaluate, select, and implement care management technology, EHR platforms, and digital tools
- Manage vendor relationships and oversee system integration and optimization
- Develop and execute within a clinical program budget
- Serve as a culture carrier and clinical role model as the team scales
Clinical Oversight & Quality- Establish and monitor documentation standards, clinical behavioral standards, and performance expectations
- Ensure regulatory compliance with Medicare billing requirements, HIPAA, state telehealth laws, and other applicable regulations
- Develop clinical risk management protocols and escalation pathways
- Oversee appropriate documentation across all systems to support compliance and billing accuracy
- Ensure time-based documentation standards are met (start time, stop time, duration tracking for monthly minute aggregation)
Measurement, Reporting & Accountability- Develop reporting frameworks for clinical outcomes, quality metrics, and compliance indicators
- Deliver clinical outcomes reporting to internal stakeholders, providers, and payers
- Track and report on program KPIs (see below)
- Use data insights to inform strategic decisions and drive program iteration
Direct Patient Care (Initial Launch Phase)- Deliver hands-on care navigation services to a limited caseload during program launch to inform workflow design
- Conduct SDOH screenings and connect patients to community resources
- Build trusted relationships with patients, families, and care teams
- Model best practices for documentation and clinical excellence
KPIs You're Responsible ForClinical Performance- Clinical team productivity (encounters per clinician, time utilization)
- Clinical outcomes (disease management metrics, care plan adherence, hospitalization/readmission rates)
- Care gap closure rate
- Escalation pattern analysis (volume trends, root cause, training signal identification)
- Patient NPS and satisfaction scores
- Patient Engagement
Program Quality & Compliance- Documentation compliance rates
- Clinical behavioral and performance standards adherence
- Clinical protocol adoption, consistency across pods, and iteration cadence
- Safety event tracking and response times
- Regulatory audit readiness
Operational Efficiency- Average time-to-resolution for patient needs
- Caseload capacity and coverage relative to patient volume
- Resource utilization rates
- Cost per patient served
- Revenue cycle metrics (as applicable)
Team & Growth- Supervisor performance and development
- Team scaling velocity and time-to-productivity for new hires
- Staff retention and engagement
Reporting & Outcomes- Timely delivery of internal, provider, and payer-facing clinical reports
- Quality of reporting frameworks and data integrity
Who You AreMust-Have Requirements- Licensed for multi-state practice - Active Nurse Licensure Compact (NLC) multistate license; prepared to obtain licensure in non-NLC states as program expands
- Clinical credentials - LVN preferred; RN considered for candidates with demonstrated leadership experience and genuine appetite for building and managing programs
- Medicare billing expertise - Direct experience working in a program that required minute-by-minute, time-based documentation for Medicare billing (CCM, TCM, PCM, CHI, RPM, or similar programs)
- Care navigation or case management experience - 3-5+ years in care navigation, case management, care coordination, or closely related patient-facing roles
- Telehealth expertise - Demonstrated ability to deliver remote care management, build rapport, and coordinate care via telephonic and digital tools
- Management experience - Proven track record leading, mentoring, or supervising clinical or operational teams
- SDOH fluency - Comfortable navigating social determinants and connecting patients to resources across complex systems
- Regulatory knowledge - Working understanding of Medicare regulations, HIPAA, and state telehealth compliance requirements
- Quality improvement experience - Track record implementing quality improvement processes to enhance clinical outcomes and operational performance
- Technology implementation - Experience evaluating, selecting, and implementing care management platforms, EHRs, or related clinical systems
- Builder mentality - You see the gap, you fill it, and you document how you did it so others can follow
- Nimble and adaptive - You thrive in ambiguity and treat a fast-changing environment as an opportunity, not a stressor
- Tech-forward - Comfortable with care management platforms, EHRs, and digital tools; quick to learn new systems
- Resilient problem-solver - You don't wait for perfect conditions; you find a way
- Low ego, high output - Equally comfortable owning the detail work and showing up credibly in strategic conversations
Nice-to-Have's- Experience in a startup, pilot program, or ground-up initiative
- Familiarity with value-based care or population health models
- Bilingual (Spanish or other languages depending on target population)
- CHW (Community Health Worker) certification
- Experience with Motivational Interviewing or trauma-informed care frameworks
- Background in vendor management or platform procurement
Why This Role- Ground-floor opportunity to shape a program from day one
- Close partnership with leadership - your voice will matter
- Competitive compensation with growth trajectory tied to program expansion
- Meaningful, mission-driven work with visible patient impact
What We Offer- Competitive compensation
- Health, Dental, and Vision insurance
- Short-term Disability and Life Insurance (100% employer-sponsored)
- Long-term Disability
- Supplemental Life Insurance (employee-sponsored)
- 401(k) Retirement Plan
- 100% Remote
- Generous paid time off and 6 paid holidays
