Registered Nurse – Virtual Care, Care Management
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Job Description
Registered Nurse managing complex patients, wellness visits, and care plans for CareTalk Health’s telehealth practice. Coordinating virtual care, closing gaps, and supporting CMS-compliant outcomes.
Responsibilities:
- Manage medically complex patients across multiple care programs, including CCM, RPM, RTM, and APCM
- Prepare comprehensive Annual Wellness Visit charts to support provider efficiency and CMS compliance
- Conduct virtual patient visits via Zoom and review medical, surgical, and family histories, medications, screenings, immunizations, and assessments
- Identify overdue screenings, risk factors, and care gaps
- Communicate patient summaries and key findings to providers
- Coordinate with patients to obtain missing or clarified information
- Provide telephonic and portal-based care management
- Conduct comprehensive nursing assessments
- Develop, implement, monitor, and update individualized care plans
- Use motivational interviewing to engage patients and caregivers
- Monitor progress, reassess goals, identify barriers, and adjust care plans
- Communicate patient status and updates to primary care providers and interdisciplinary teams
- Provide patient education, coaching, and support
- Act as patient advocate and escalate issues when appropriate
- Identify and close preventive, laboratory, medication, and follow-up care gaps
- Coordinate orders, referrals, follow-up actions, services, and providers
- Maintain accurate, timely, and confidential patient records
- Use CT360, RXNT, Zoom, EHR systems, and telehealth platforms
- Support clinical quality, patient engagement, and satisfaction outcomes
- Follow HIPAA, CMS, and organizational compliance standards
- Participate in professional development and ongoing training
- Perform other duties as assigned
Requirements:
- Active, unrestricted Registered Nurse (RN) license in a compact state
- Ability and willingness to obtain additional state licenses upon hire (company paid)
- Minimum 3 years of clinical nursing experience, including bedside, Primary Care, Med/Surge, or Home Health experience
- Experience providing care in a telehealth or virtual care setting
- Experience working remote
- Experience in Chronic Care Management (CCM), Remote Patient Monitoring (RPM), telehealth or virtual care coordination, primary care, or care management
- Proficiency with EHR systems and telehealth platforms
- Strong clinical assessment and care coordination skills
- Excellent verbal and written communication skills
- High level of organization, attention to detail, and time management
- Ability to work independently in a remote environment
- Commitment to patient-centered, culturally competent care
- Dedicated, private home workspace
- Reliable internet connectivity
- Windows or Apple (macOS) computer only; no Chromebooks, Linux machines, or smartphones
- Windows 10 or macOS 14 Sonoma minimum
- Intel Core i5 or AMD equivalent processor for Windows, or Apple Silicon for Macs
- 16 GB RAM
- Wired headphones required; no built-in microphones
- Minimum internet speed of 100 Mbps download and 50 Mbps upload
- Ethernet cable connecting computer directly to router
- Google Chrome with Amazon Workspaces
- Webcam required for video calls
- Preferred: Medicare Annual Wellness Visit experience, CMS documentation and preventive care knowledge, case management or gerontological nursing certification, and experience across multiple virtual care programs and platforms
Benefits:
- Ability and willingness to obtain additional state licenses upon hire (company paid)
- 40 hours per week
- Professional development and ongoing training
- Remote work from a home office
- Equal opportunity and inclusive work environment
- Recommended second monitor; dual monitors for PC users
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