About Us: At POD Health, we redefine healthcare with Personalized Outcomes Delivered – equity-driven, patient-focused care. As Providers on Demand, we are committed to breaking barriers and ensuring high-quality healthcare is accessible to all. Our telemedicine practice specializes in Telehealth, Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and Chronic Health Integration (CHI) for Medicare patients, combining innovative technology with compassionate care to meet patients where they are. Join us in advancing healthcare equity and fostering healthier communities. Reports To : Nurse Manager Job Summary: The Registered Nurse (RN) will play a pivotal role in supporting the Director of Advanced Practice Providers (APPs) and Nurse Practitioners in delivering high-quality healthcare services. This role focuses on reviewing and administering care plans for RPM, CHI, and CCM services, ensuring seamless coordination and optimal patient outcomes. The RN will conduct telehealth visits, enhance care plans for existing patients, and ensure all encounters advance patient care while meeting productivity benchmarks for billable time. In addition, the RN will assist the NP team in carrying out their key responsibilities, fostering a collaborative and efficient care environment. Key Responsibilities: 1. Remote Patient Monitoring (RPM): + Review and analyze patient data collected through RPM devices, ensuring timely intervention for health concerns. + Educate patients on using RPM technology effectively and troubleshoot any device-related issues. + Assist NPs in interpreting complex RPM data and implementing actionable care strategies. 2. Chronic Care Management (CCM): + Collaborate with NPs to develop and oversee comprehensive care plans for patients with chronic conditions. + Ensure consistent follow-up between patient visits to address health goals such as medication adherence and lifestyle changes. + Provide additional support in patient education and compliance monitoring to achieve long-term health outcomes. 3. Community Health Integration (CHI): + Participate in programs targeting underserved populations to reduce healthcare disparities and improve access to care. + Collaborate with NPs and local health organizations to implement CHI initiatives and track their impact on community health. + Assist in identifying and addressing social determinants of health that affect patient care outcomes. 4. Patient-Centered Care: + Conduct comprehensive health assessments and assist NPs in addressing acute and chronic patient needs. + Actively consider cultural, socioeconomic, and health literacy factors when coordinating care. + Provide patient education to enhance understanding and compliance with care plans. 5. Telehealth Services: + Deliver telehealth consultations in coordination with NPs, ensuring seamless care delivery for patients. + Support NPs by triaging patient inquiries, managing follow-ups, and addressing immediate concerns. 6. Care Coordination: + Work closely with Medical Assistants, Care Navigators, and NPs to streamline workflows and reduce hospital readmissions. + Create a Patient Care Plan for all new enrollments + Work directly with Complex Cases and multi-diagnoses patient. + Conduct Daily Charts review + Schedule escalation visits with the providers for patients with change in health statuses + Actively participate in training for new hires (MA) + Facilitate warm handoffs between care team members for RPM, CCM, and CHI services. + Act as a liaison to ensure smooth collaboration among interdisciplinary team members. 7. Documentation and Compliance: + Maintain timely and accurate patient records for RPM, CCM, and CHI services. + Ensure adherence to HIPAA and telehealth-specific regulations, supporting NPs in maintaining compliance. + Perform regular audits of patient documentation to identify areas for improvement. 8. Outcome Optimization: + Track and report key metrics for RPM, CCM, and CHI, including patient engagement rates and program outcomes. + Collaborate with NPs to continuously improve clinical processes based on performance data and patient feedback. + Support quality assurance initiatives to meet organizational benchmarks and patient care goals Requirements: + Active and unrestricted RN license in the State of New York. + Bachelor’s or Associate’s degree in Nursing (BSN preferred). + Experience in telehealth, RPM, CCM, or CHI services is highly desirable. + Strong communication, organizational, and problem-solving skills. + Demonstrated ability to work collaboratively in a team-oriented, patient-focused environment. POD Health provides equal employment opportunities to all employees and applicants for employment without regard to race, religion, color, ethnic origin, gender, gender identity, age, marital status, veteran status, sexual orientation, disability, or any other basis prohibited by applicable federal, state, or local law. Employment Type Full-Time Compensation $105,000 - $110,000 per year