Job Description
Nurse Practitioner (NP) ā Transitional Care Management (TCM) Provider (Remote)
Position Overview
We are seeking a licensed Nurse Practitioner (NP) to provide Transitional Care Management (TCM) services for patients discharged from our partner skilled nursing facilities. This role focuses exclusively on conducting post-discharge patient visits via telehealth (video or phone) to support continuity of care, improve outcomes, and reduce readmissions.
- Key Responsibilities
- Conduct Transitional Care Management (TCM) visits for patients following discharge from skilled nursing facilities
- Perform patient encounters via video or phone (fully remote role)
- Review and synthesize clinical data from hospital and post-acute care stays
- Assess patient status, address clinical needs, and provide appropriate care guidance
- Document visits accurately and efficiently within the designated platform
- Communicate clearly with patients, caregivers, and care teams
- Manage and maintain a full patient schedule based on availability
- Navigate clinical situations appropriately and escalate when necessary
- Utilize technology platforms to deliver care and manage workflows
- Deliver high-quality patient care exclusively in a virtual environment
- Visit Structure & Work Environment
- Visits typically last up to 20 minutes per patient
- Flexible patient volume based on provider schedule and availability
- 100% remote ā no field work, bedside care, or in-person clinical responsibilities
- Fully technology-enabled care delivery model
- Required Qualifications
- Active and unrestricted Nurse Practitioner license
- Experience reviewing and synthesizing clinical information from hospital and post-acute care settings
- Strong clinical judgment and patient care skills
- Excellent communication and patient engagement abilities
- Highly tech-savvy and comfortable using digital health platforms
- Ability to manage schedules independently and maintain productivity
- Comfortable working exclusively in a remote, telehealth-based environment
- Preferred Qualifications (Optional)
- Prior experience with Transitional Care Management (TCM) services
- Experience in skilled nursing, post-acute care, or care coordination
- Telehealth or virtual care delivery experience
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