Fully Remote Chronic Care Manager (RN)

At Vitability Health of New Jersey, we believe great care goes beyond checklists and charts—it’s about relationships, trust, and walking alongside patients as they navigate life with chronic conditions. Our mission is to improve quality of life through thoughtful, personalized care that meets patients where they are and supports them every step of the way.

We are looking for a compassionate and experienced Chronic Care Manager (RN) who is passionate about caring for patients over the long term. In this role, you will build meaningful relationships with patients, help them better understand and manage their health, and serve as a steady, trusted presence in their care journey. This position is ideal for a nurse who values connection, collaboration, and purpose—and who enjoys using clinical expertise to make a real difference, all while working remotely.

Provide ongoing chronic care management to a caseload of patients living with multiple chronic conditions Develop and maintain personalized care plans that reflect each patient’s goals, challenges, and needs Conduct comprehensive assessments to understand medical, social, and lifestyle factors affecting health Monitor patient progress, identify changes early, and adjust care plans to support better outcomes Educate and encourage patients and their families on disease management, medications, and healthy lifestyle choices Use telehealth and remote monitoring to stay connected with patients between visits Partner with Care Navigators (social workers) by delegating tasks and supporting their work to ensure seamless, high-quality care Collaborate with providers and interdisciplinary team members to promote continuity and alignment across care Support medication reconciliation and help patients feel confident in understanding their treatment plans Assist with coordinating appointments, tests, and follow-ups to reduce barriers to care Help patients access community resources and support services that enhance overall well-being Work proactively to reduce hospital readmissions and emergency department visits through consistent engagement Maintain clear, timely, and compliant documentation in the EHR in accordance with HIPAA and CMS guidelines Track patient outcomes and quality measures to help strengthen and grow our care management programs Stay informed on best practices and evolving standards in chronic care management