Nurse Practitioner (Remote, CT License Required)
Core
Provide post-hospital discharge follow-up care via phone and video to patients with complex medical needs, focusing on medication reconciliation, symptom screening, and care coordination.
Role type
Nurse Practitioner (Population Health/Transitions of Care)
Builds
Telehealth care pathways for post-discharge patients
Domain
Healthcare / Population Health / Transitions of Care
Deliverable
clinical care delivery
Required skills
medication reconciliation, symptom screening, care coordination, motivational interviewing, virtual care delivery, complex case management
Preferred skills
Skilled-Nursing facility experience, Medicare/Medicaid population management, bilingual (English/Spanish), Google Suite proficiency
Responsibilities
Conduct telephonic outreach and scheduled video/phone visits for recently discharged patients, coordinate care across hospital, ED, pharmacies, and community providers, collaborate with nursing teams, meet individual and team population health targets
Seniority
Mid-Senior level (5+ years post-graduate experience required)