Nursing degree from an accredited institution (ADN or BSN required; BSN preferred)
5+ years of broad clinical nursing experience
3+ years in care management, telehealth, or chronic disease management
Strong computer proficiency, including EHR documentation
Active, unrestricted RN license, with Compact (NLC) or California RN license as needed
Responsibilities
Conduct comprehensive telephonic and virtual clinical assessments
Develop and implement individualized nursing care plans
Engage patients using Motivational Interviewing techniques
Identify clinical risks and escalate urgent situations appropriately
Collaborate with interdisciplinary care teams to coordinate care
Deliver proactive interventions to reduce hospitalizations and ER visits
Document all patient interactions accurately in the EHR
Benefits
Opportunity to work at the forefront of virtual care
Mission-driven culture focused on innovation and patient impact
Supportive, remote-first work environment
Growth opportunities within the organization
Full Job Description
Position Summary
The Telephonic Nurse Care Manager is responsible for the remote, telephonic management of patients with chronic and complex conditions (including but not limited to CHF, COPD, diabetes, and hypertension). This role partners closely with patients, caregivers, and interdisciplinary care teams to assess health status, develop and implement evidence-based care plans, monitor biometric and IVR data, and intervene proactively to reduce risk, prevent escalation, and improve outcomes.
This is a remote position requiring strong clinical judgment, excellent communication skills, and comfort working in a technology-enabled, fast-paced virtual care environment.
Key Responsibilities
Conduct comprehensive telephonic and virtual clinical assessments, including review and interpretation of biometric, RPM, and IVR data with trend analysis
Develop, implement, and adjust individualized nursing care plans aligned with patient goals, evidence-based practice, and organizational protocols
Engage patients using Motivational Interviewing techniques to drive behavior change, adherence, and self-management
Identify clinical risks, changes in condition, and urgent situations; escalate appropriately and in accordance with clinical guidelines
Collaborate with interdisciplinary care teams (internal and external) to coordinate care, referrals, and transitions across the continuum
Deliver proactive interventions aimed at reducing hospitalizations, ER visits, and overall cost of care
Document all patient interactions accurately, timely, and comprehensively in the electronic health record (EHR)
Participate in quality improvement initiatives, chart audits, and performance reviews to enhance clinical outcomes and care delivery
Perform care management activities in alignment with client-specific workflows, performance expectations, and service-level requirements
Maintain compliance with all clinical, regulatory, HIPAA, and organizational standards
Core Competencies
Strong clinical assessment and critical-thinking skills in a remote care setting
Excellent time management and organizational skills with the ability to prioritize effectively
High degree of accountability for patient safety, outcomes, and care quality
Ability to work independently while remaining highly collaborative within a virtual team
Exceptional verbal and written communication skills
Strong relationship-building skills with patients, caregivers, colleagues, and clients
Comfort navigating multiple technology platforms and adapting quickly to new tools
Education & Experience Requirements
Nursing degree from an accredited college or university (ADN or BSN required; BSN preferred)
Minimum of 5 years of broad clinical nursing experience
Minimum of 3 years of experience in one or more of the following:
