About the role
Aledade partners with independent primary care practices nationwide to help them succeed in value-based care. As a Clinical Outreach Specialist on the Aledade Plus team, you'll manage a telephonic caseload of recently discharged patients — closing care gaps and smoothing the handoff back to their primary care practice before small issues turn into readmissions.
Responsibilities
- Place and field calls to patients and caregivers to coordinate post-discharge follow-up, lab work, screenings, and appointments
- Reconcile medications and document every intervention accurately across multiple partner EHRs
- Educate patients on their care plan, check eligibility for concurrent programs, and work through hesitation about next steps
- Partner with primary care practices on programs such as Transitional Care Management and Osteoporosis Management in Women
- Act as a clinical resource for the team and help identify ways to improve outreach workflows
- Meet individual performance and quality metrics across a fast-paced, high-acuity caseload
Requirements
- Practical Nursing certificate/diploma or Associate Degree in Nursing
- Current, unrestricted LPN license
- 2+ years of clinical experience in case management or discharge planning
- Prior experience with telephonic patient outreach and clinical assessment
- Comfortable prioritizing high-acuity cases and making fast clinical judgment calls
- Strong communication skills and experience with EHR/population-health tools
- Able to work independently as part of a distributed, interdisciplinary team
What we offer
- Remote-first schedule flexibility
- Medical, dental, and vision coverage with up to 80% employer-paid premiums
- 21 days of PTO in year one, plus 11 paid holidays and 2 volunteer days
- 12 weeks paid parental leave and a 6-week paid sabbatical after 6 years
- 401(k) with up to a 4% match, plus stock options
- Education and clinical certification reimbursement