Remote Nurse Practitioner Chronic & Transitional Care; -State Telehealth

Job Title:

Remote Nurse Practitioner – Chronic & Transitional Care (50-State Telehealth Role)

Location:

Fully Remote – United States
Active multi-state licensure required; ability to practice autonomously where state law allows strongly emphasized

Job Type: Full-Time | Flexible Scheduling

We are a nationally focused, forward-thinking telehealth organization dedicated to improving outcomes for patients with chronic and complex conditions. Through evidence-based Chronic Care Management (CCM) and Transitional Care Management (TCM) programs, we support Medicare beneficiaries and other high-risk populations across the country.

Our model empowers Nurse Practitioners to practice at the top of their license—delivering high-quality, patient-centered care remotely while making a measurable impact on hospital readmissions, patient engagement, and long-term health outcomes.

We are seeking an experienced Remote Nurse Practitioner to deliver CCM and TCM services to patients nationwide. This role offers the opportunity to practice independently and autonomously where permitted by state law, while collaborating with an interdisciplinary care team in a fully virtual environment.

You will serve as a clinical leader for your patient panel—owning care plans, managing chronic conditions, and guiding patients through critical post-discharge transitions using telehealth technology.

• Independently develop, implement, and manage comprehensive, patient-centered care plans for CCM patients.
• Conduct scheduled non-face-to-face care management encounters (phone and video) to assess clinical status, medication adherence, and progress toward goals.
• Deliver Transitional Care Management services, including timely post-discharge outreach, medication reconciliation, and coordination of follow-up care.
• Educate patients and caregivers on disease management, symptom monitoring, and lifestyle modification.
• Manage acute clinical changes remotely, escalating care appropriately while ensuring continuity and patient safety.
• Collaborate with physicians, specialists, pharmacists, and community resources to optimize outcomes.
• Document all care accurately in the EHR to meet CMS CCM/TCM billing and compliance standards.
• Participate in shared team coverage to ensure 24/7 patient support.

• Master’s or Doctoral degree in Nursing from an accredited program.
• Active, unrestricted Nurse Practitioner license (APRN) with national certification (FNP, AGNP, or Adult/Gerontology).
• Multi-state licensure required; compact license or willingness to obtain additional state licenses strongly preferred.
• Minimum of 2–3 years of Nurse Practitioner experience, ideally in primary care, geriatrics, care management, or chronic disease management.
• Prior experience with Medicare CCM and/or TCM programs highly desirable.
• Strong clinical judgment with the ability to practice independently in a remote setting.
• Proficiency with telehealth platforms, EHR systems, and remote patient monitoring tools.
• Reliable high-speed internet and a private, HIPAA-compliant workspace.

• Clinicians who value autonomy, accountability, and patient ownership.
• Strong communicators with a compassionate, coaching-oriented approach.
• Comfort managing complex chronic conditions using evidence-based guidelines.
• Tech-forward providers who thrive in a virtual care environment.

• Competitive salary, commensurate with experience, plus performance-based incentives.
• Flexible scheduling to support long-term work-life balance.
• Paid time off, holidays, and continuing education support.
• Professional development opportunities and licensure reimbursement to support multi-state practice.
• A collaborative, mission-driven culture focused on clinician satisfaction and patient outcomes.

We are an equal opportunity employer and value diversity, inclusion, and clinical excellence across our national care team.