Registered Nurse | Clinical Care Management
1101
Clinical Care Management Registered Nurse (CCM RN)
Full-Time | Remote | Monday–Friday Are you an experienced Registered Nurse who enjoys using your clinical judgment to make a meaningful difference in the lives of patients? Do you thrive in a role where you can combine clinical assessment, triage, care coordination, patient education, and relationship-building? Oak Medical is looking for a Clinical Care Management Registered Nurse (CCM RN) to join our team and help support the ongoing healthcare needs of patients with chronic conditions in long-term care and senior living settings. This is an excellent opportunity for a nurse who enjoys being a clinical resource and advocate while working closely with patients, families, facility staff, providers, and other healthcare professionals. This is a full-time, remote position. The CCM RN may occasionally travel to our corporate office in Waukesha, Wisconsin for training. What You'll Do As a CCM RN, you will serve as an important point of contact for clinical concerns and help ensure patients receive timely, coordinated, and appropriate care. Your responsibilities will include:- Provide clinical triage by responding to calls, electronic messages, and health concerns from patients, families, facility staff, and care partners.
- Use your clinical judgment and assessment skills to determine the appropriate level of care, from routine follow-up and education to provider notification or urgent escalation.
- Conduct telephonic, electronic, and occasional in-person assessments related to symptoms, changes in condition, chronic conditions, medications, and other health concerns.
- Develop and maintain individualized care plans in collaboration with patients, families, facility staff, providers, and the healthcare team.
- Coordinate referrals, medication questions, lab and order clarification, DME needs, prior authorizations, follow-up care, and other patient needs.
- Provide education and reassurance to patients, families, and facility staff regarding chronic disease management, medications, preventive care, symptom monitoring, and when to seek additional medical attention.
- Monitor patients' needs and follow-up plans, ensuring recommendations and provider-directed interventions are completed timely.
- Accurately document clinical encounters, assessments, interventions, care coordination, and follow-up in accordance with established protocols and regulatory requirements.
- Support Medicare Part B Chronic Care Management (CCM) services and documentation requirements.
- Collaborate with a multidisciplinary team to identify opportunities to improve the quality and coordination of care for our patients.
- 🏡 Remote work environment
- 📅 Monday–Friday schedule
- ❤️ Meaningful work supporting the health and well-being of seniors
- 🤝 Collaboration with an experienced multidisciplinary healthcare team
- 🩺 An opportunity to use your clinical judgment, assessment, and triage skills in a different way
- 📚 Opportunities to grow your knowledge of chronic care management and care coordination
- 💰 401(k) with employer contribution
- 🏥 Medical, Dental & Vision Insurance
- ❤️ Employer-paid Life Insurance
- Current, unrestricted Wisconsin RN license
- Strong clinical assessment and critical thinking skills
- Excellent communication and interpersonal skills
- Ability to manage multiple priorities and respond appropriately to time-sensitive clinical concerns
- Ability to work independently while collaborating effectively with a multidisciplinary team
- Knowledge of geriatric care and the unique healthcare needs of seniors
- Familiarity with electronic health records
- BSN
- Certification in Gerontology or Chronic Care Management (CCM)
- Experience in triage, senior living, long-term care, care coordination, or a similar nursing role
- Experience with Medicare Part B Chronic Care Management programs or CMS quality reporting
