- Conduct virtual onboarding E/M visits, including history, assessment, documentation, orders/referrals, and follow-up planning
- Provide clinical decision-making between visits; ensure timely care and appropriate escalation
- Coordinate with member PCPs and specialists to support continuity of care
- Review RPM data, alerts, and trends to identify members needing outreach or escalation; document clinical interpretation and route follow-ups appropriately
- Escalate clinical concerns to the Clinical Director and/or medical directors per protocol
- Partner with care managers to design, review, and approve individualized care plans aligned to evidence-based guidance and member goals
- Provide day-to-day clinical guidance to care navigators and care managers; unblock escalations and mentor on documentation quality and escalation judgment
- Help refine clinical workflows, templates, and protocols to improve safety, efficiency, and member experience
- Identify gaps and propose improvements based on recurring needs, outcomes, and team feedback