RN Remote Patient Monitoring (RPM) & Chronic Care Management (CCM)

HealthWorks Medical•Paducah, KY

6d•Remote

About The Position

The Registered Nurse (RN) provides clinical oversight and patient care management within Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) programs. This role focuses on evaluating patient data, coordinating care, and supporting patients with chronic conditions through ongoing monitoring and engagement. The RN collaborates with providers and care teams to improve patient outcomes, reduce hospitalizations, and ensure high-quality, compliant care delivery.

Requirements

Active and unrestricted Registered Nurse (RN) license
Associate or Bachelor of Science in Nursing (BSN preferred)
Minimum of 1–3 years of clinical nursing experience (primary care, case management, or chronic disease management preferred)
Experience with telehealth, care management, or remote monitoring programs preferred
Familiarity with EHR systems and digital health platforms
Strong clinical assessment and critical thinking skills
Advanced patient assessment and clinical judgment
Strong communication and patient education skills
Care coordination and case management expertise
Attention to detail and accurate documentation
Ability to work independently in a remote or hybrid environment
Proficiency with healthcare technology and data monitoring tools

Nice To Haves

Experience with Medicare CCM/RPM billing and documentation requirements
Background in population health or care management programs
Certification in case management (e.g., CCM, RN-BC)
Experience managing patients with chronic conditions such as diabetes, hypertension, COPD, or heart failure

Responsibilities

Review and interpret patient-generated health data (e.g., blood pressure, glucose, pulse oximetry, weight) from RPM platforms
Assess patient conditions and identify trends, risks, or abnormalities requiring intervention
Develop, implement, and update individualized care plans in collaboration with providers
Conduct routine and as-needed patient outreach via phone or telehealth for CCM and RPM services
Provide clinical education on disease management, medications, and lifestyle modifications
Triage patient concerns and escalate urgent or complex cases to providers as needed
Coordinate care among primary care providers, specialists, and other healthcare team members
Ensure accurate and timely documentation in the electronic health record (EHR)
Track and document time and services in compliance with CMS guidelines for RPM and CCM billing
Support quality improvement initiatives and patient engagement strategies
Supervise and support Medical Assistants or care coordinators involved in RPM/CCM workflows (if applicable)
Maintain compliance with HIPAA and all regulatory requirements