Remote Complex Care Coordination RN (Hybrid Telehealth)

Sun River Health; Village of Monticello (NY); Hybrid; USD 63,000 - 76,000; Full time

Job summary

Sun River Health in Monticello, NY is seeking a Complex Care Coordination RN (HV Region) to provide remote nursing support across multiple HV sites within a hybrid framework. The RN will perform telephonic triage, chronic disease management, and coordinate timely follow‑ups, extending on‑site capacity and ensuring care gaps are closed.

The role emphasizes care coordination for complex chronic conditions in rural HV North locations, with strong emphasis on documentation, escalation, and

Qualifications

• Current, unencumbered RN license in New York.
• BSN preferred; ADN considered.
• Care coordination, care management, or telehealth experience preferred.
• Experience with chronic disease management (CHF, diabetes, hypertension).
• Proficiency with electronic health records and telehealth tools.
• Strong clinical assessment and communication skills.
• Bilingual English/Spanish preferred; CPR/BLS current.

Responsibilities

• Provide remote care‑coordination support across HV North sites.
• Identify discharges and initiate post‑discharge outreach within 24–48 hours.
• Conduct telephone medication reconciliation and renewals per protocol.
• Coordinate with site teams using EHR and open communication channels.
• Assist with prior authorizations, referrals, and follow‑ups where capacity is limited.
• Track and meet Transitional Care Management and Complex Care Coordination requirements.
• Deliver telephonic patient education on medications and self‑care.
• Escalate red‑flag symptoms to providers per policy.

Skills

Care coordination

Chronic disease management

Telehealth/triage

Clinical assessment

Remote communication

Bilingual (English/Spanish)

CPR/BLS

Strong written and verbal skills

Education

RN license NY

BSN preferred; ADN considered

Tools

Electronic Health Records (EHR)

Standard office productivity tools

Job description

Sun River Health in Monticello, NY is seeking a Complex Care Coordination RN (HV Region) to provide remote nursing support across multiple HV sites within a hybrid framework. The RN will perform telephonic triage, chronic disease management, and coordinate timely follow‑ups, extending on‑site capacity and ensuring care gaps are closed.

The role emphasizes care coordination for complex chronic conditions in rural HV North locations, with strong emphasis on documentation, escalation, and