Conduct annual health risk assessments for medically complex patients in home settings or via telehealth.
Responsibilities
- Assess and document patients’ health conditions and social needs.
- Provide comprehensive visit notes and maintain accurate clinical documentation.
- Coordinate appropriate referrals and help guide care next steps.
- Communicate effectively with patients, caregivers, primary care providers, and interdisciplinary care teams.
Key skills
- Strong clinical assessment and documentation skills.
- Ability to manage complex medical and social factors.
- Excellent communication and care coordination across stakeholders.
- Comfort working in-person and via telehealth.