Remote Chronic Care RN - CCM/RPM Specialist

Senscio Systems; Gardner (MA); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

PTO

Paid holidays

401(K)

Insurance programs

CEU reimbursement

Job summary

Senscio Systems is seeking a compassionate Registered Nurse (RN) for a full-time, remote Chronic Care Management and Remote Patient Management role. You'll provide telephonic support, care coordination, patient education, and documentation for patients with multiple chronic conditions, ensuring proactive outreach and timely follow-up.

The position is remote in the United States, with responsibilities including care planning, medication reconciliation, EHR documentation, and after-hours

Qualifications

• Active, unrestricted RN license for MA; multi-state license preferred.
• 1–2 years in primary care, internal medicine, case management, home health, or care coordination.

Responsibilities

• Conduct monthly CCM telephone encounters (≥20 minutes).
• Develop, update and document individualized care plans.
• Reconcile and review medications.
• Assess health status, adherence, symptoms, and plan progress.
• Monitor vital signs remotely and respond to trends.
• Educate patients on disease management and lifestyle changes.
• Identify barriers to care and coordinate with the care team.
• Maintain thorough EHR documentation.
• Support care transitions post-hospitalization when needed.
• Respond to patient messages and alerts within defined timeframes.
• Comply with CMS CCM; HIPAA and organizational protocols.

Skills

Communication

Assessment

Critical thinking

Patient education

Care coordination

Education

Registered Nurse (MA) license

Tools

EHR systems

Job description

Senscio Systems is seeking a compassionate Registered Nurse (RN) for a full-time, remote Chronic Care Management and Remote Patient Management role. You'll provide telephonic support, care coordination, patient education, and documentation for patients with multiple chronic conditions, ensuring proactive outreach and timely follow-up.

The position is remote in the United States, with responsibilities including care planning, medication reconciliation, EHR documentation, and after-hours