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Mediation represents a process in which language serves as a tool for constructing and negotiating meaning, essential for social participation and the communication dynamics associated with it (CoE 2020). The right to health is one of the main pillars of social security systems in European countries with democratic traditions (Fondazione ISMU ETS 2024: 103). In the healthcare sector, mediation emerges as a core competency, particularly as globalization and global migration over the past two decades have led to increasing numbers of professionals – including physicians, nurses, nursing assistants, and caregivers – relocating across the globe. However, in the processes of language assessment, mediation has long been overlooked or reduced to written or oral interaction, as well as to practices such as interpreting and translation (Barni and Machetti 2006). In this context, the spread of the Learning-Oriented Assessment (LOA) model (Purpura and Turner 2018), now also applied to L2 Italian within Scenario-Based Assessment (Purpura 2021), represents an innovation. This approach makes it possible to integrate mediation into multimodal mechanisms, leveraging both technological tools and the dynamics of interactive communication. This study examines best practices and challenges in linguistic and cultural mediation within healthcare settings, using the Erasmus+ PULSE 2.0 project, a European consortium, as a case study, with a particular focus on its application in Italy. The project was designed to enhance language, communication, and intercultural skills essential for medical workplaces in the nursing and caregiving sectors. Adopting an LOA approach, PULSE 2.0 accounted for the multiple factors involved in language use and treated assessment as interrelated with learning and teaching across defined dimensions. Within this framework, it integrated mediation as a central component, offering an innovative model for addressing these complex competencies. The PULSE 2.0 project developed two key tools: a language assessment tool measuring proficiency in healthcare contexts and a digital learning tool for self-training. These tools have improved healthcare professionals’ linguistic and intercultural competencies, enhancing employability and communication in diverse medical settings.