Identifies applicable patient cohorts through use of various data sources and, through multi-channel patient outreach, schedules patients for specified care needs. Completes prospective patient care assessments to assess patient’s overall health and physician condition. This will be accomplished by identifying potential risk factors, evaluating current symptoms, and notifying providers prior to visit of, but not limited to, any open gaps in care, patient risk documentation needs, over utilization trends, patient needs, and social determinants. Candidate must have current LPN license or Medical Assistant certification.