Position Summary
The Transitional Care Management (TCM) Nurse is a U.S.-licensed Registered Nurse responsible for delivering high-quality, post-discharge care coordination services to patients across multiple programs. This role focuses on ensuring safe transitions of care, reducing readmissions, and improving patient outcomes through timely outreach, clinical assessment, education, and coordination.
This position is based in Ormoc, Leyte, Philippines, and supports U.S. patient populations and health plan partners, requiring alignment with U.S. clinical, regulatory, and documentation standards (including HIPAA compliance).
Key Responsibilities
- Contact patients after discharge and complete TCM assessments
- Review medications, discharge plans, and identify risks
- Coordinate follow-up care and referrals
- Escalate clinical concerns to U.S. providers
- Document all interactions in the EMR
- Support care coordination across programs
- Communicate clearly with patients and provide education
Qualifications
- Active U.S. RN license
- 2–3 years clinical experience
- Knowledge of U.S. healthcare and HIPAA
- Strong English communication skills
Preferred
- TCM, case management, or telehealth experience
- Familiarity with CMS guidelines and Medicare Advantage
- Experience with EMR systems