Job Description: The Hub RN provides nursing support for the care team, and is available to support and consult on member specific needs (e.g., inperson visits, clinical education, targeted clinical interventions). The HUB RN also ensures safe and compliant clinic operations from a nursing perspective with occasional crossover into the provision of community health minded services. Responsibilities: Receive incoming calls from members needing clinical triage, providing decision support to determine if urgent clinical responses are necessary. Ensure clinical safety and appropriate onsite triage, performing additional nonstandard assessments or previsit testing as requested by providers. Conduct inperson clinical examinations when appropriate to support comprehensive care. Participate in interdisciplinary case conferences and implement population health campaigns, such as vaccination efforts and addressing lost to care lists. Act as a clinical resource for team members, assisting with clinical goals, education, and acute clinical needs. Triage member needs during clinical visits, provide education, communicate test results promptly, and address member needs with timely task delegation. Deliver episodic care management for identified members, conducting meetings in the hub as extensions of primary care teams, including medication reconciliation, standing orders, minor procedures, and disease management education. Support Medical Assistant duties, including rooming patients, taking vitals, drawing labs, performing EKGs, administering injections, and safely escalating or handing off care to longitudinal providers. Provide nursing support to bridge onsite care with field based services, ensuring medication reconciliation, administration, compliance, education, and managing medication refills per standing protocols. Address quality gaps prioritized by the company, ensuring proper chart documentation and coding, and maintaining safe, compliant clinic operations. Occasionally engage in community health services and support outpatient care with care facilitation and electronic health record platforms for data collection, task tracking, and documentation. Manage FIT testing and PPE for COVID19 and respiratory exposures, place vaccine orders with temperature control checks, and oversee clinical stock inventory and nursing bag kit distributions. Provide clinical education and training on medical equipment and chronic disease management to less intensively trained staff, such as Medical Assistants and Community Health Partners. Review and sign off on clinical competencies related to PointofCare Testing and procedures. Seamlessly integrate data collection and documentation into operations and reporting using standardized care facilitation and electronic health record platforms. Facilitate effective communication within teams and with community resources to ensure coordinated care delivery. Work Experience: 3+ years of experience We take into account an individual’s qualifications, skillset, and experience in determining final salary. This role is eligible for health insurance, life insurance, retirement benefits, participation in the company’s equity program, paid time off, including vacation and sick leave. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location. The expected salary range for this position is: $71,000.00 - $90,500.00 Annual Cityblock values diversity as a core tenet of the work we do and the populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic. Medical Clearance (for Member-Facing Roles): You must complete Cityblock’s medical clearance requirements, which include, but may not be limited to, evidence of immunity to MMR, Hepatitis B, Varicella, and a TB screen, or have an approved medical or religious accommodation that precludes you from being vaccinated against these diseases. We do not accept unsolicited resumes from outside recruiters/placement agencies. Cityblock will not pay fees associated with resumes presented through unsolicited means.
Job Description: This is a clinical role. The Advanced Community Care Clinician is responsible for delivering medical care in the communities where Cityblock members live. In homes, shelters, offices, public places or in the street. The ACCC/AC3 is primarily responsible for facilitating virtual provider visits with Cityblock members and following medical orders, performing clinical skills and tasks within their scope, training, and policy. Which may include, IV insertion, IV/IM/SQ medication administration, 12 EKG, Phlebotomy, etc. (Dependent upon local legal regulations). Responsibilities: The Advanced Community Care Clinician will play a vital role in delivering this model of care by making sure they are well equipped, operationally ready, certified, trained, and effective. Cityblock delivers integrated primary and acute medical care, behavioral health and social care, powered by relationships and designed to advance equity in access and outcome. By delivering these acute and longitudinal services in-home through a combination of digital and in-person connections, we can allow members to stay at home and out of the hospital. The Advanced Community Care Clinician is pivotal in connecting members to Cityblock services including medical providers and access to all Cityblock services. There are several primary visit types they will be responsible for: ED@home: Acute illness facilitated provider visit Facilitated Visit: Longitudinal care team facilitated provider visit Outreach: Independent visit to find hard to reach members Specimen Collection: Independent visit to obtain tissue samples for the lab. MIC Only Follow-up: Independent visit with a specific set of visit goals Each shift the Advanced Community Care Clinician will begin their day reviewing their equipment, communications, and scheduled visits. They will plan to integrate mandatory training, meetings, and lunch into their day at pre-planned times or in any down time. Before the visit they will review Commons and Athena for any warning or instructions about the visit. Review the need for written consent. Arrive 10 minutes prior to the start of the visit and make member contact. Introduce themself and describe how a visit is conducted Complete required charting and activities prior to bringing the virtual provider on video. Use the Cityblock computer to facilitate a video visit. Carryout any instructions like order or examinations, sometimes on camera and sometimes independently as instructed. Post visit they will complete documentation, process lab work in a centrifuge and decontaminate their equipment. They will then get themselves set for the next visit by restocking and preparing equipment. Their vehicle whether Cityblock owned or personal; will be kept, maintained and used in accordance with company policy. Work Experience: 4+ Years Education: Bachelor's degree We take into account an individual’s qualifications, skillset, and experience in determining final salary. This role is eligible for health insurance, life insurance, retirement benefits, participation in the company’s equity program, paid time off, including vacation and sick leave. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location. The expected salary range for this position is: Cityblock values diversity as a core tenet of the work we do and the populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic. We do not accept unsolicited resumes from outside recruiters/placement agencies. Cityblock will not pay fees associated with resumes presented through unsolicited means.
Job Description: The Medical Assistant provides direct services to members and performs various office and clinical duties to keep our healthcare practice running efficiently. Responsibilities: Answers phone calls and greet patients as they enter the facility Assists the nurse and office manager in maintaining the medical inventory and placing orders for new materials as needed. Assists healthcare providers with clinical procedures, examinations, diagnotsitc testing, specialized clinical procedures as authorized Administers medications and vaccines under the direction of a licensed healthcare provider. Outreaches / engages members to schedule provider visits for annual visits, discharge follow up, chronic disease management, and addresses HEDIS gaps Coordinates patient care activities, including scheduling appointments, obtaining referrals, and managing patient follow-up. Maintains accurate and up-to-date patient records, including entering information into electronic health record (EHR) systems. Manages the inventory of medical supplies and medications, reordering as needed. Completes pre- and post- visit chart prep for provider visits; ensures all quality and patient outcome metrics are elevated for providers to address. Work Experience: 1+ years of experience working in a clinical operations setting We take into account an individual’s qualifications, skillset, and experience in determining final salary. This role is eligible for health insurance, life insurance, retirement benefits, participation in the company’s equity program, paid time off, including vacation and sick leave. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location. The expected salary range for this position is: $20.19 - $25.96 Hourly Cityblock values diversity as a core tenet of the work we do and the populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic. We do not accept unsolicited resumes from outside recruiters/placement agencies. Cityblock will not pay fees associated with resumes presented through unsolicited means.
Job Description: Cityblock’s Transition of Care (TOC) program helps members safely navigate their post-discharge journey from acute care and hospital settings back into the community. The TOC Registered Nurse Care Manager (RNCM) coordinates with hospital case managers to determine members’ needs and to complete discharge visits (in-home or virtual) with members and providers. The TOC RNCM will also be available for referrals to triage members’ needs and provide clinical education, with the goal of helping ensure that members do not return to the hospital. Responsibilities: Assign members and initiate outreach by contacting hospital case managers to understand each member's unique needs before engaging them in the TOC program. Complete self-efficacy and condition-specific screeners during the assess and intake phase, including behavioral health tools like PHQ-9, GAD-7, AUDIT, or DAST-10, to identify members requiring behavioral health programming. Conduct in-person clinical exams if appropriate and collaborate with care team members to determine if a different intensity program placement is needed. Participate in daily inpatient rounds while members are admitted, followed by post-discharge case conferences to support discharge planning. Collaborate with the TOC Care Coordinator and TOC Behavioral Health Specialist to develop post-discharge care plans addressing needs and barriers, ensuring smooth recovery and effective hand-off to longitudinal care. Perform regular check-ins guided by the TOC program, including post-discharge home visits and weekly follow-ups for four weeks, ensuring provider visits are completed and addressing member needs promptly. Meet members in various community settings such as homes, SNFs, IRFs, shelters, and hospitals, providing support for both clinical and non-clinical needs. Conduct comprehensive medication reconciliation and address contracted and company-prioritized quality gaps, ensuring proper chart documentation and appropriate ICD or CPT coding as evidence of gap closure. Utilize care facilitation, electronic health records, and scheduling platforms to collect data, document member interactions, organize information, track tasks, and communicate effectively with the team, members, and community resources. Track TOC-related metrics for assigned members, logging new TOC events and follow-up metrics to monitor progress effectively. Work Experience: 3+ Years of experience Education: Graduate of an accredited school of nursing (R.N.) We take into account an individual’s qualifications, skillset, and experience in determining final salary. This role is eligible for health insurance, life insurance, retirement benefits, participation in the company’s equity program, paid time off, including vacation and sick leave. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location. The expected salary range for this position is: $71,000.00 - $90,500.00 Annual Cityblock values diversity as a core tenet of the work we do and the populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic. We do not accept unsolicited resumes from outside recruiters/placement agencies. Cityblock will not pay fees associated with resumes presented through unsolicited means.
Job Description: The Pod Provider delivers comprehensive chronic disease management (e.g. hypertension, diabetes, chronic kidney disease), evaluation of acute concerns, behavioral health condition management (i.e. depression, anxiety, alcohol and substance use disorder), and preventative care and wellness support (including sexual and reproductive health). The role works collaboratively with an interdisciplinary team of clinical and non-clinical members to develop member care plans and to support members throughout their care journey. The Pod Provider also assists with the development and enhancement of clinical programs, initiatives, processes, and policies. Monday-Friday:8am-5pm This is a Hybrid Role, based in the Cleveland, OH market Responsibilities: Conduct comprehensive clinical intake visits. Provide longitudinal direct primary care or wrap-around care with focus on chronic condition management and preventative care. timely follow-up for members post transition of care event, acute need or according to condition-specific needs. Proactively outreach to members who need follow up care. Complete comprehensive and compliant diagnosis capture related to HCC (Hierarchical Condition Categories) and ICD-10 (International Classification of Diseases-10) Coding. Address contractual and company-prioritized quality gaps and ensure proper chart documentation and codes (ICD or CPT) are included in the encounter as supporting evidence of gap closure. Prescribe 1st and 2nd line medications for depression, anxiety, alcohol use disorders and opioid use disorders. Remain up to date on evidence-based care for complex patients in primary care: (adult only, pediatric in certain markets). Refer member to specialist care appropriately and according to internal CBH guidance if available. Support the member in achieving the goals in their care plans (physical, behavioral, and/or social health). Participate in case conferences with the care team, providing clinical expertise on care plan development. Provide guidance on highest impact clinical interventions and tasks to achieve a member’s goals. Collaborate on a panel of members to provide clinical input, including health maintenance, chronic disease management and co-occurring psychiatric disorder support. Work Experience: 3+ experience We take into account an individual’s qualifications, skillset, and experience in determining final salary. This role is eligible for health insurance, life insurance, retirement benefits, participation in the company’s equity program, paid time off, including vacation and sick leave. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location. The expected salary range for this position is: 125,000.00 - 135,000.00 Salary Cityblock values diversity as a core tenet of the work we do and the populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic. Medical Clearance (for Member-Facing Roles): You must complete Cityblock’s medical clearance requirements, which include, but may not be limited to, evidence of immunity to MMR, Hepatitis B, Varicella, and a TB screen, or have an approved medical or religious accommodation that precludes you from being vaccinated against these diseases. We do not accept unsolicited resumes from outside recruiters/placement agencies. Cityblock will not pay fees associated with resumes presented through unsolicited means.
