Chronic Care Management Nurse

CCM Nurse (RN, LVN LPN)

Position Summary
Join a well-established, independent practice with a long history in the San Joaquin Valley. At the heart of our compassionate, patient-centered practice is a family-like team of hard-working professionals who maintain a stable environment where your expertise is respected and your well-being is a priority.

SCMG is dedicated to providing our partners in the cardiology space with the tools and resources needed to implement meaningful programs like remote patient monitoring and chronic care management in their cardiology practices.

With a focus on quality patient care and innovative solutions, SCMG requires additional dedicated staff to improve patient outcomes, promote patient engagement and support therapy compliance through a Chronic Care Management program. Joining our team as a Nurse (RN, LVN LPN), you will have the opportunity to connect with patients daily and support their cardiac needs from the comfort of your home. As a valued team member, you will collaborate with other experts in the cardiology space to improve patient outcomes and positively impact the future of specialty medicine.

Major Areas of Responsibility

• Welcome patients into continuous care program(s) and review benefits and services included
• Coordinate with the patient’s provider to ensure a collaborate approach to care

• Educate patients on the frequency and use of their assigned in-home monitoring devices, if applicable

• Create a personalized, comprehensive care plan with the patient via phone or video visits

• Identify and address any barriers to patient success

• Provide specific education and coaching on patients’ chronic cardiac conditions

• Connect with the patient frequently to review readings and update their plan of care monthly

• Serve as the patient’s first contact for all non-emergent needs (example – medication refills, scheduling, appointment reminders, etc.)

• Assist patients in the navigation of their healthcare (example – assisting patients with scheduling appointments, coordinating with specialists, and ensuring preventative screenings are completed, etc.).

• Review and evaluate in-home device readings in real time, during normal business hours

• Follow established protocols for identifying, communicating and documenting device trends and any associated symptoms in the patient’s medical record

• Escalate concerning readings and/or symptoms to the provider following a communication protocol established by the provider

• Establish a meaningful rapport that builds trust, open communication, and motivation to make a positive change in the patient’s health

Supervision
Supervision is provided by the Nursing Manager and attending physicians in the Clinic.

Knowledge and Skills

• At least three (3) years of experience in adult health preferred

• Background in adult chronic health conditions (Cardiology, Care Management) preferred

• Experience using a variety of Electronic Health Records systems (EHR)
• Proficient knowledge, skill, and interest in basic computer skills

• Proficient in problem solving and ability to multi-task

• Excellent communication skills (oral and written)

• Excellent teamwork skills

• Clean background check and drug screening

• Comfortable working remotely but collaboratively


Education and Experience

• Successful completion of an Nursing program
• At least three (3) years of experience in adult health preferred
• Background in adult chronic health conditions (Cardiology, Care Management) preferred

• Experience using a Variety of Electronic Health Record systems (EHR)

Licensure / Certification
RN, LVN, or LPN

Compensation
$60k-75k Annual Salary DOE

We provide a comprehensive benefits package, including:

• Health Insurance
• Dental Insurance
• 401(k)
• 10% employer contribution to 401(k)
• PTO
• 10 Paid Holidays