Transitional Care Management Nurse Practitioner Remote

Remote Full-time
Nurse Practitioner (NP) β€” 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
β€’ Conduct Transitional Care Management (TCM) visits for patients following discharge from skilled nursing facilities
β€’ Perform patient encounters via video or phone (fully remote role)
β€’ Review and synthesize clinical data from hospital and post-acute care stays
β€’ Assess patient status, address clinical needs, and provide appropriate care guidance
β€’ Document visits accurately and efficiently within the designated platform
β€’ Communicate clearly with patients, caregivers, and care teams
β€’ Manage and maintain a full patient schedule based on availability
β€’ Navigate clinical situations appropriately and escalate when necessary
β€’ Utilize technology platforms to deliver care and manage workflows
β€’ Deliver high-quality patient care exclusively in a virtual environment

Visit Structure & Work Environment
β€’ Visits typically last up to 20 minutes per patient
β€’ Flexible patient volume based on provider schedule and availability
β€’ 100% remote β€” no field work, bedside care, or in-person clinical responsibilities
β€’ Fully technology-enabled care delivery model

Required Qualifications
β€’ Active and unrestricted Nurse Practitioner license
β€’ Experience reviewing and synthesizing clinical information from hospital and post-acute care settings
β€’ Strong clinical judgment and patient care skills
β€’ Excellent communication and patient engagement abilities
β€’ Highly tech-savvy and comfortable using digital health platforms
β€’ Ability to manage schedules independently and maintain productivity
β€’ Comfortable working exclusively in a remote, telehealth-based environment

Preferred Qualifications (Optional)
β€’ Prior experience with Transitional Care Management (TCM) services
β€’ Experience in skilled nursing, post-acute care, or care coordination
β€’ Telehealth or virtual care delivery experience

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