Transitional Care Management Nurse Practitioner Remote

Trio Health Partners embodies the fundamental philosophy of prioritizing the three pillars crucial to exceptional patient care: facility, family, and provider. As a multi-specialty clinical service provider, we are dedicated to improving clinical outcomes and preventing re-hospitalizations for patients in skilled nursing and long-term care facilities. Through our full-time clinicians dedicated to your facility, Providers are seamlessly integrated into their respective disciplinary teams, working collaboratively and fully aligned towards a shared vision and common goals.

Nurse Practitioner (NP) — Transitional Care Management (TCM) Provider (Remote) Position Overview: We are seeking a licensed Nurse Practitioner (NP) to provide Transitional Care Management (TCM) services for patients discharged from our partner skilled nursing facilities. This role focuses exclusively on conducting post-discharge patient visits via telehealth (video or phone) to support continuity of care, improve outcomes, and reduce readmissions.

Conduct Transitional Care Management (TCM) visits for patients following discharge from skilled nursing facilities Perform patient encounters via video or phone (fully remote role) Review and synthesize clinical data from hospital and post-acute care stays Assess patient status, address clinical needs, and provide appropriate care guidance Document visits accurately and efficiently within the designated platform Communicate clearly with patients, caregivers, and care teams Manage and maintain a full patient schedule based on availability Navigate clinical situations appropriately and escalate when necessary Utilize technology platforms to deliver care and manage workflows Deliver high-quality patient care exclusively in a virtual environment Visit Structure & Work Environment Visits typically last up to 20 minutes per patient Flexible patient volume based on provider schedule and availability 100% remote — no field work, bedside care, or in-person clinical responsibilities Fully technology-enabled care delivery model