Remote Registered Nurse Care Coach

Summary

Join CircleLink Health as a remote RN Care Coach and serve patients enrolled in Medicare's Chronic Care Management Program, providing education, coordinating care, and coaching on self-management strategies.

Requirements

• Current, unrestricted New York License
• Proficiency with electronic health records and web based applications
• 10+ years experience as a Registered Nurse
• Fluent in English
• Self-directed, able to work independently with little supervision while meeting performance metrics
• Passion for nursing and improving patient outcomes
• Good with technology and eager to learn and use new software
• Excellent organizational and time management skills
• Strong communication and telephonic skills
• Strong critical thinking and problem solving skills

Responsibilities

• Utilize our specialized care management software to call Medicare patients with 2 or more chronic conditions (Diabetes, CHF, Chronic Pain, COPD, etc.) on a monthly basis
• Build and maintain rapport with patients to help coach them to improved health through SMART goals and education on self-management strategies
• Implement and improve the Plan of Care by updating medications, appointments due, biometrics, symptoms, and interventions made
• Connect the patient with community resources as needed, including transportation, personal care needs, prescription/DME assistance, social services, etc
• Conduct Transitional Care Management activities to high risk patients discharged from the hospital and the ER to reduce unnecessary readmissions
• Close care gaps by encouraging and assisting with preventive care measures, i.e. annual well visits, vaccines, cancer screens, follow-up/specialist appointments, etc

Preferred Qualifications

• Case Management or Chronic Disease Management experience
• Certified Diabetes Educator
• Experience with Motivational Interviewing or other behavior change communication techniques

Benefits

• Compensation is paid at the rate of $15.00 per initial Clinical Encounter per patient per month
• Pay Timing: Monthly via direct deposit, 40 days after the last day of the month of service