Integrated Care Coach

Integrated Care Coach provides proactive, patient-centered care coordination and social needs support for high-risk patients, serving as the primary contact for patients and coordinating care across health and social service systems. Responsibilities include conducting structured clinical interviews, home visits to assess living conditions and safety, identifying barriers to care and connecting patients with community resources, delivering culturally appropriate chronic disease education, facilitating care transitions and follow-up, and liaising between patients, primary care providers, specialists, and home health. The role requires experience in ambulatory/primary care or senior care, ability to discuss chronic conditions and adherence, comfort with home visits and community outreach, and a track record of patient education and social support for high-risk or geriatric populations. The work style blends in-center and field activities with roughly two days per week in clinic and two days in patients’ homes, and is situated in the Olathe, KS area within CenterWell Senior Primary Care / Humana. Travel to patients’ homes and clinics is expected, with a schedule Monday–Friday, 8:00 AM–5:00 PM.