Registered Nurse - Chronic Care Management (CCM RN)

We are seeking a dedicated and compassionate Chronic Care Management (CCM) Registered Nurse (RN) to provide care coordination, patient education, and ongoing support for individuals with chronic conditions. The CCM RN will work closely with patients, families, and healthcare providers to develop personalized care plans that improve health outcomes, enhance patient engagement, and reduce hospitalizations. 

Key Responsibilities: 

• Provide telephonic and telehealth chronic care management services for patients with multiple chronic conditions. 

• Conduct comprehensive assessments and develop individualized care plans in collaboration with patients and their healthcare providers. 

• Educate patients on disease management, medication adherence, lifestyle modifications, and self-care strategies. 

• Coordinate with physicians, specialists, and other healthcare professionals to ensure continuity of care. 

• Monitor patient progress and adjust care plans as needed to meet health goals. 

• Support patients in navigating healthcare resources, scheduling follow-ups, and accessing community services. 

• Utilize electronic health records (EHR) and Population Health platform, to document patient interactions and maintain compliance with CMS Chronic Care Management program guidelines. 

• Identify and address barriers to care, including social determinants of health. 

• Participate in quality improvement initiatives to enhance patient outcomes and optimize chronic disease management programs. 

• Use subject matter expertise in CCM to assist in the development of the CCM program. 

Requirements

• Education - Associate's or Bachelor's degree in Nursing (BSN preferred)

• Licensure - Active RN license in NY State (or compact licensure if applicable)

• Experience - Minimum of 5 years of nursing experience, ambulatory and/or outpatient chronic disease management, care coordination, or case management
• Experience - Launching new programs and mentoring new care managers

• Certifications: Case Management certification (CCM) preferred 
• Clinical Judgment – Demonstrates advanced clinical knowledge and critical thinking to develop and adapt care plans based on patient needs. Strong clinical knowledge of chronic conditions such as diabetes, hypertension, COPD, heart disease, and others
• Patient-Centered Care – Demonstrates empathy, compassion, and cultural sensitivity while building trusted relationships with patients and families
• Care Coordination – Skilled in managing care across multiple providers, settings, and disciplines to ensure continuity and quality
• Communication – Communicates effectively with patients, families, and the care team, both verbally and in writing, across various platforms (phone, telehealth, EHR)
• Health Coaching & Education – Empowers patients through effective education and motivational interviewing to support behavior change and self-management
• Technology Proficiency – Comfortable navigating EHRs, population health tools, and telehealth technologies to support remote care delivery
• Team Collaboration – Ability to work independently and as part of an interdisciplinary healthcare team. 
• Adaptability – Thrives in a dynamic environment with evolving priorities, especially in the context of new program development and regulatory standards.
• Quality Improvement Orientation – Actively participates in and contributes to quality initiatives that drive improved patient outcomes and program effectiveness.

Benefits

VATICA HEALTH ADVANTAGES

• Every single person at Vatica Health is working to fight the good fight every single day. What we do matters, a lot. If you are looking for a job that has real meaning and you’d like to work with people who care deeply about what they do, we’ve got that.
• We work hard (see point above), but we don’t forget to have fun. “I want a job that is dull,” said no one ever.
• We believe in fostering a culture of servant leadership – command and control is so 1990s. We look for brilliant people that are great at what they do because they love what they are doing.
• We know that teams are exponentially more successful than the sum of their individuals. Our teams value what each member brings to the table and also values continuous improvement of each team member as well as the whole team.
• We love learning. And we love working with people who love learning. Our industry changes every single day; stagnation is not an option.

Prosperity

• Competitive salary based on your experience and skills – We believe the top talent deserves the top dollar
• Bonus Potential (based on role and is discretionary) – If you go above and beyond, you should be rewarded
• 401k match– We want to empower you to prepare for your future
• Room for growth and advancement- We love our employees and want to develop within

Good Health

• Comprehensive Medical, Dental, and Vision insurance plans
• Tax-free Dependent Care Account and Flexible Spending Account
• Life insurance, short-term, and long-term disability

Happiness

• 4 weeks of PTO (Everyone deserves a vacation now and then)
• M-F work week (No working weekends, overnights, on call shifts, or holidays)
• Reimbursement for RN license and Continuing Education Credits
• Strong supportive teams- There is always a helping hand when you need it!

The salary for a position is typically determined by multiple factors such as the individual's qualifications, experience, skills, and location. The projected compensation range for the position may vary based on these factors and could range from $65,000 to $85,000 (annualized USD). However, this estimate represents just one aspect of our total compensation package offered.

Are you up to the challenge? What are you waiting for? Apply today!