Remote Chronic Care Nurse (RN) - Patient-Centered CCM

Vitability Health; Florence (AL); Remote; USD 85,000 - 110,000; Full time

Job summary

Vitability Health of New Jersey is seeking an experienced Chronic Care Manager (RN) to provide comprehensive, patient-centered care remotely. You will build durable relationships with patients, manage chronic conditions, and guide them through ongoing treatment plans in collaboration with a multidisciplinary team.

You will lead personalized care plans, conduct thorough assessments, and support patients and their families with education on medications and lifestyle changes, all while maintaining

Qualifications

• Active RN license in New Jersey or a valid Compact RN License
• Experience in Chronic Care Management (CCM)
• Required acute care nursing experience
• Patient-centered approach and strong communication

Responsibilities

• Provide ongoing chronic care management to a caseload of patients with multiple chronic conditions
• Develop personalized care plans reflecting patient goals and needs
• Conduct comprehensive assessments of medical, social, and lifestyle factors
• Monitor patient progress and adjust care plans to improve outcomes
• Educate patients and families on disease management, medications, and healthy lifestyles
• Utilize telehealth and remote monitoring to stay connected between visits
• Collaborate with Care Navigators and interdisciplinary team to ensure high-quality care
• Support medication reconciliation and understanding of treatment plans
• Coordinate appointments, tests, and follow-ups to reduce barriers to care
• Help patients access community resources and support services

Skills

Chronic Care Management (CCM)

Registered Nurse (RN) license

Acute care nursing experience

Strong communication

Tools

EHR systems

Telehealth platforms

Remote patient monitoring tools

Job description

Vitability Health of New Jersey is seeking an experienced Chronic Care Manager (RN) to provide comprehensive, patient-centered care remotely. You will build durable relationships with patients, manage chronic conditions, and guide them through ongoing treatment plans in collaboration with a multidisciplinary team.

You will lead personalized care plans, conduct thorough assessments, and support patients and their families with education on medications and lifestyle changes, all while maintaining