Medical Assistant - Transitional Care Coordinator (Waco, TX)

Location: Waco, TX About Us Ennoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, Oklahoma, Kansas, Pennsylvania, Texas, Florida, Ohio, Kentucky, Mississippi, and Georgia. Ennoble Care’s clinicians go to the home of the patient, providing continuum of care for those with chronic conditions and limited mobility. Ennoble Care offers a variety of programs including, remote patient monitoring, behavioral health management, and chronic care management, to ensure that our patients receive the highest quality of care by a team they know and trust. We seek individuals who are driven to make a difference and embody our motto, “To Care is an Honor.” Join Ennoble Care today! Ennoble Care is seeking a full-time Certified Medical Assistant to serve as a Transitional Care Coordinator on a set weekly rotation among our partnered skilled nursing and rehabilitation facilities in Waco, Texas . The right person for this role is reliable, self-motivated, vigilant, and compassionate. This is an integral, on-site role as part of our clinical care team, working closely alongside our providers in a family-practice-style model built around continuity, relationship-building, and patient-centered support. You'll get to know the residents (and their families) over time, watch for changes in condition, and play a meaningful, hands-on role in helping people stay healthy, avoid unnecessary hospitalizations, and stay where they call home. We're proud of the culture we've built at Ennoble Care -- one that is positive, respectful, and rooted in genuine teamwork. People here are valued, supported in doing work that matters, and encouraged to maintain a healthy work-life balance. We invest in our team's growth through internal advancement opportunities based on performance, organizational needs, and role availability, because we believe that when our team thrives, so do our patients. ABOUT THE ROLE As a Medical Assistant - Transitional Care Coordinator, your focus will be transitional care management, attentive patient monitoring, and day-to-day collaboration with our clinical team and facility staff - keeping residents, families, facility staff, and our Housecalls division informed and care on track. A day in this role You'll rotate among two or more partnered skilled nursing and rehab facilities in the Waco area on a set weekly schedule, usually spending the full day at one facility and occasionally covering two. Your day includes checking in with residents, flagging changes in condition to our providers, and keeping Ennoble and facility records in sync. When residents are ready to discharge home, you'll help make sure their first Housecalls visit happens quickly and that our Housecalls team is ready to pick up their care. Over time, you'll get to know residents, families, and facility staff well, and you'll become the person they rely on. WHAT YOU'LL GET $18.00/hour starting (higher rates available based on experience) + performance bonus Weekday schedule, approximately 8:00am to 5:00pm CST, with no weekends, evenings, overnights, or on-call Seven (7) company-paid holidays, plus PTO and paid sick time Medical, dental, and vision benefits, plus 401(k) with up to 3% company match A growth path into a Lead Coordinator role for high performers REQUIRED QUALIFICATIONS Legally authorized to work in the United States of America Current medical assistant certification: CMA (AAMA), RMA (AMT), CCMA (NHA), or NCMA Minimum 1 year of patient-facing experience in a clinical setting; long-term care, skilled nursing or post-acute experience strongly preferred Comfortable communicating proactively throughout the day in person, by phone, via email, and through Microsoft Teams Solid working knowledge of healthcare terminology and care coordination principles Ability to observe, recognize, and promptly report changes in a patient's condition to the provider Experience with EMR systems and clinical documentation; Point Click Care experience preferred Proficient with Microsoft 365 including Excel, Outlook, Word, and Teams Excellent communication and interpersonal skills, with a solid foundation in organization, time management, and clinical documentation Capacity to work independently while collaborating closely with multidisciplinary teams Ability to work full-time, on-site, five weekdays per week in the Waco, Texas area Ability to pass background check Transportation criteria: Valid, unencumbered driver's license Reliable personally-owned vehicle Current auto insurance, with the ability to provide proof KEY RESPONSIBILITIES Care Coordination & Transitional Care Management Coordinate care for patients residing in skilled nursing and rehabilitation facilities using Ennoble Care's EMR Facilitate transitional care management, ensuring services with the Housecalls division are initiated immediately when a resident discharges home from the facility Expedite time to the first Housecalls provider visit for residents transitioning home, in accordance with established guidelines Monitor patients attentively, promptly report changes in condition to the provider, carry out provider-directed follow-up, and support escalation of care as clinically indicated, including CCM-billable activities Consistently support care coordination efforts to reduce avoidable emergency department visits and hospital readmissions Collaborate daily with providers and facility staff to ensure care plans are kept current and acted on On-Site Clinical Support Maintain a consistent and reliable daily on-site presence at your assigned facility Build ongoing relationships with residents and their families, reinforcing trust and continuity of care over time Perform regular patient check-ins to support care plans, follow-ups, and clinical stability Identify changes in patient condition and promptly communicate concerns to the clinical team Communication & Collaboration Serve as the key liaison between Ennoble Care providers, facility staff, residents, families, and the Housecalls team, ensuring accurate, timely exchange of clinical information Provide timely, accurate clinical updates to providers to support informed decision-making Educate eligible residents and families about Ennoble Care's Housecalls program and support their enrollment Documentation & EMR Management Accurately document patient interactions, observations, and care coordination activities in Ennoble Care’s EMR Perform chart reconciliation to ensure accuracy and continuity of clinical records between Ennoble and facility records Follow established workflows, documentation standards, and escalation protocols Growth & Team Contribution Contribute positively to team collaboration and build strong partnerships with facility staff Promote best practices in transitional care, communication, and facility-based care coordination High performers have a growth path into a Lead Coordinator role, mentoring and training new team members Work Environment & Expectations Embedded, on-site role within partnered skilled nursing and/or rehabilitation facilities Set weekly rotation among Waco-area facilities, typically one facility per day, occasionally two Requires consistent daily presence and strong relationship-building with facility staff Fast-paced, patient-facing role requiring sound judgment, adaptability, and proactive engagement CORE COMPENTACIES Patient-centered care Clinical observation and escalation Care coordination and continuity Communication and collaboration Documentation accuracy and compliance Relationship-building and teamwork COMPENSATION & BENEFITS Starting pay rate is $18.00/hour (higher rates available based on experience) Performance bonus earned monthly on four clear metrics: timely first Housecalls visits after discharge home, discharge process completion, provider visit flagging, and CCM visit completion, plus an extra bonus when all four are met Mileage reimbursement for travel between sites during the workday (commute to your assigned facility is not reimbursed) Full-time health benefits eligibility, including a range of supplemental insurance options and elective benefits Please answer all application questions thoroughly. Thank you for your interest in joining the Ennoble Care team! ❤️ #brown Full-time employees qualify for the following benefits: Medical, Dental, Vision and supplementary benefits such as Life Insurance, Short Term and Long Term Disability, Flexible Spending Accounts for Medical and Dependent Care, Accident, Critical Illness, and Hospital Indemnity. Paid Time Off Paid Office Holidays All employees qualify for these benefits: Paid Sick Time 401(k) with up to 3% company match Referral Program Payactiv: pay-on-demand. Cash out earned money when and where you need it! Candidates must disclose any current or future need for employment-based immigration sponsorship (including, but not limited to, OPT, STEM OPT, or visa sponsorship) before an offer of employment is extended. Ennoble Care is an Equal Opportunity Employer, committed to hiring the best team possible, and does not discriminate against protected characteristics including but not limited to - race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status.