- Conduct telehealth-based E/M or Annual Wellness Visits to establish medical necessity for care navigation services.
- Identify high-risk conditions and unmet social needs during intake visits.
- Document clinical findings in the platform using accurate coding, SDOH Z-codes, and relevant diagnoses.
- Develop and approve individualized care plans for patients.
- Collaborate with care advocates and nurse care managers to align plans with medical and social needs.