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Role Description

The Remote Nurse is a key member of the Outer Cape Health Services (OCHS) clinical team, delivering high-quality, patient-centered care in a virtual environment. This position supports providers, medical assistants, behavioral health specialists, and other team members to ensure timely, coordinated, and comprehensive care for patients. The remote nurse will focus on triage, care coordination, chronic disease management, and panel management, leveraging technology and clinical protocols to maintain continuity of care and close care gaps.

A Day in the Life of this Role:

Summary of Duties:

Essential Functions

• Conduct nurse visits via telehealth for chronic disease management, blood pressure checks, INR reviews, medication education, and post-hospital discharge follow-up.
• Perform triage using approved clinical protocols, assess patient needs, and coordinate same-day care when necessary.
• Exhibit a high level of clinical acumen and decision-making to address patients’ acute and chronic needs as part of a highly functioning team.
• Reinforce treatment plans for chronic conditions (e.g., diabetes, hypertension, asthma).
• Process medication refill requests per standing protocols and ensure accurate documentation.
• Educate patients on proper use of medical equipment, prescribed regimens, and other self-care practices.
• Provide a patient-centered experience by addressing questions, explaining procedures or testing, and connecting patients with community resources or support programs.

Care Coordination & Panel Management

• Collaborate with providers and team members to close care gaps and ensure follow-up on labs, referrals, and preventive services.
• Participate in pre-visit planning, leveraging standing orders to improve care delivery.
• Review dashboards and outreach to patients to schedule recommended visits and screenings.
• Assist with care transitions and follow-up after hospital or ED discharge.

Team-Based Care & Quality Improvement

• Actively participate in virtual team huddles, case conferences, and interdisciplinary care planning.
• Support population health initiatives and quality improvement projects to advance OCHS’ strategic goals.
• Facilitate coordination with specialty care, social services, and community-based resources to meet patient needs.

Documentation & Compliance

• Maintain accurate and timely documentation in the Electronic Medical Record (EMR) per OCHS policies.
• Manage all assigned in-baskets including telephone encounters, patient messages, and overdue results.
• Perform pre-visit medication reconciliation when indicated.
• Communicate abnormal and normal results promptly to providers and patients.
• Ensure compliance with HIPAA, infection control standards, and organizational clinical protocols.

Collaboration & Communication

• Promote teamwork by collaborating with providers, Medical Assistants, and Patient Service Representatives.
• Seek guidance from the Nurse Manager for escalated concerns or complex clinical issues.
• Contribute to a culture of safety by adhering to National Patient Safety Goals (e.g., patient identification, medication safety, infection prevention).

Work Environment

• Fully remote position with reliable high-speed internet required.
• Occasional on-site meetings or trainings may be required.
• Must maintain a HIPAA-compliant home office environment for patient confidentiality.

Qualifications

• BLS/CPR certification required.
• Minimum of 1–2 years of clinical nursing experience preferred, ideally in a primary care or community health setting.
• Experience or desire to work in team-based care model.
• Bachelor of Science or Associates in Nursing from an accredited school of nursing by AACN.
• Current Registered Nurse (RN) license from the Massachusetts State Board of Registration.
• Maintain and enhance professional nursing skills and knowledge by attending continuing education programs.
• Excellent interpersonal skills, communication skills, organizational abilities, computer experience, and the ability to work within a collaborative team setting.
• Excellent written and verbal communication skills – bi-lingual helpful.
• Proficiency in computer skills including EPIC, Outlook, Microsoft Office, OneDrive, etc.
• Excellent judgment and ability to solve problems in a timely manner.
• Ability to adhere to strict confidentiality standards.
• Demonstrated ability to work effectively both as a team member and independently.
• Demonstrated ability to work in a culturally diverse and inclusive environment.

Company Description

Outer Cape Health Services is committed to providing equal employment opportunity in all our employment programs and decisions. Discrimination in employment on the basis of any protected class under federal, state, or local law is a violation of our policy and is against the law. Equal employment opportunity is provided to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, covered veterans' status, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, political affiliation, or any other protected characteristic.

In accordance with Massachusetts law, we are committed to wage transparency. The salary range for this position is $35.00/hourly to $45.00/hourly. This range is provided to promote equity and transparency in our hiring process. Actual compensation may vary based on factors such as experience, qualifications, and other job-related criteria.