Virtual Care Management RN

This position manages high-risk, chronic illness patients to promote effective education, self-management support, and timely healthcare delivery to achieve optimal quality outcomes. Responsibilities include post-discharge patient intake interviews to answering requests for nursing escalation by patients or the Remote Care Coordinator team at Connected Home Living. Aim to improve quality of care through the ecient use of resources and thereby enhance quality and cost-effective outcomes. This position is committed to the constant pursuit of excellence in improving the health status of the community.

To succeed in this position, candidates should be organized, compassionate, empathetic and have exceptional communication, computer, and problem-solving skills. You should possess interpersonal skills and be resourceful, analytical, and adaptable, with the ability to build rapport with team members, clients, and partners.

Utilize telehealth and remote patient monitoring to evaluate patients’ biometric data, health surveys, trend analysis, and overall clinical status.

• Collaborates with patients, remote care coordinators, nurses, patients’ families, caregivers, physicians, and all members of the healthcare team, both internal and external to this organization.
  • Utilizes the predefined protocol process to set priorities, plan, organize, and implement goal-directed interventions toward self-care/long-term care outcomes and the transition to stabilization or independent status.
• Intervene promptly to prevent patient emergency room visits.
• Promote quality and cost-effective interventions and outcomes.
• Documents accurately, comprehensively, and in a timely manner based on the standards of practice and current organizational policies.
• Interacts and communicates telephonically, using video or other technologies to be developed, striving for continuity and efficiency as the member/patient is managed along the continuum of care.
• Participate in training, scheduling in-services and staff meetings.
• Support and uphold all Connected Home Living policies and service philosophy.
• Upholds Clients’ Rights as defined by California state regulations and Connected Home Living policy at all times.
• Virtual Admission Visit within 48 hours of new patient notification.
  • Perform Assessment using the Virtual Case Management (RN) Initial Assessment and chart in the Telehealth Portal.
  • Medication Reconciliation.
  • Patient Education- review common symptoms that can be expected for diagnosis.
  • Discuss the following with pt/caregiver.
    • Program is Free and lasts 30 days but may be extended if needed.
    • Ask if they have a doctor’s follow-up appt. Make sure you have the name and number of the PCP and Cardiologist.

• Alert escalations within 30 minutes of notification.
  • From a HIPAA-compliant space, perform a Zoom call with the patient to address their concerns.
  • Chart notes in the Telehealth Portal.
• Perform other duties as assigned.

• A minimum of 5 years of professional-level medical experience with a concentration in emergency or urgent care, cardiac care, post-op care, or experience in care coordination is preferred.
• Experience working with electronic medical records required.
• Ability to communicate effectively with providers and medical sta.
• Excellent organizational skills and ability to handle multiple priorities while remaining calm and
• professional.
• Ability to be self-motivating and work independently.
• Computer skills: proficient to expert
• Must have exceptional time management, writing, verbal communication, and critical thinking skills.

● Proficiency in Microsoft Office (Word, Excel, PowerPoint) and Google Workspace (previously Google G suite) required.

• Organized, detail-oriented, analytical, and Client-focused.
• Strong understanding of cultural competency

Education and Experience Requirements:

• RN required.
• California license and registration required.
• Proficiency in medication indications and side effects.
• Understanding medical tests and requirements for tests to provide the patients with appropriate information.
• Bilingual applicants preferred (Spanish and Mandarin/Cantonese)

Work environment

• This is a remote position.
• Ability to work independently and successfully with minimal direct oversight is required.
• Work is performed primarily in a standard oce setting with constant public contact (via telephone or video technology) with frequent interruptions.
• Ability to work well within a cross-functional team environment and diverse communities.

Physical Requirements:

Primary functions require sufficient physical ability and mobility to work in an office setting; to stand or sit for prolonged periods; to occasionally stoop, bend, kneel, crouch, reach, and twist; to lift up to 40 pounds, carry, push, and pull light to moderate amounts of weight; to operate office equipment requiring repetitive hand movement and fine coordination including use of a computer keyboard; and to verbally communicate to exchange information.