Licensed Practical Nurse - Mountain Time Remote

Role Responsibilities:

• Perform monthly CCM touchpoints for assigned patient panels.
• Build strong, ongoing relationships with patients and caregivers through regular outreach.
• Review patient chart data before calls.

Clinical Assessments & Judgment:

• Conduct structured symptom assessments.
• Evaluate changes in condition using licensed clinical judgment.
• Assess medication adherence issues.

Escalation, Coordination & Provider Communication:

• Escalate urgent issues based on defined triage pathways.
• Collaborate with the provider team on symptom changes.
• Assist in coordinating care

Care Plan Reinforcement & Patient Education:

• Reinforce provider-developed CKD and chronic disease care plans.
• Provide clinical explanation of symptom management instructions.
• Support adherence to medications, lifestyle changes, and follow-up instructions.