Resource Registered Nurse; RN - Population Health - Remote; Ohio Residents

Job Description

This is a 100% remote position; however, candidates must reside in Ohio. The Resource RN provides nursing support to members with low‑acuity, short‑term clinical needs. The role does not carry an assigned member panel; instead, the Resource RN works from a task‑based queue to address targeted clinical needs. Care is delivered virtually and in person, as appropriate.

• Outreach to members while admitted inpatient or after inpatient or emergency department discharge to conduct focused transitions of care assessments.
• Outreach to case managers for members that are admitted inpatient to assist with discharge planning as needed.
• Complete self‑efficacy and condition‑specific screeners including behavioral health tools like PHQ‑9, GAD‑7, AUDIT, or DAST‑10, to identify members requiring behavioral health programming.
• Conduct in‑person clinical exams if appropriate and collaborate with care team members to determine if a different intensity program placement is needed.
• Conduct comprehensive medication reconciliation and address contracted and company‑prioritized quality gaps, ensuring proper chart documentation and appropriate ICD or CPT coding as evidence of gap closure.
• Triage referrals from the Population Health Partner for short‑term clinical interventions and chronic disease management.
• Meet members in various community settings such as homes, shelters, or hospitals, serving as an extender of care team providers and performing tasks like administering injections, monitoring vital signs, and in‑home medication reconciliation.
• Review charts and data signals for potential transition to higher level of complex care management.
• Facilitate follow‑ups and hand‑offs to care team as needed.
• Utilize care facilitation, electronic health records, and scheduling platforms to collect data, document member interactions, organize information, track tasks, and communicate effectively with the team, members, and community resources.

• Timely outreach to members and hospital case managers for transitions of care support.
• Completion of focused transitions of care assessments, ensuring accurate medication reconciliation and follow‑up visits are scheduled.
• Identification and timely escalation of members requiring higher‑intensity programs or behavioral health interventions.
• Completion of assigned queue tasks within established timelines.
• Efficient management of multiple short‑term clinical assignments without compromising quality.
• Effective communication and collaboration with care team members, Population Health Partners, and community providers.

• Graduate of an accredited school of nursing (R.N.).
• 3+ years of nursing experience.
• Strong critical thinker with sound clinical judgment who makes complex decisions independently and knows when to collaborate.
• Identifies system barriers to care and develops creative, practical solutions.
• Demonstrates a growth mindset and openness to innovative approaches to improve outcomes.
• Strong written and verbal communication across phone, text, virtual, and in‑person settings.
• Comfortable using technology to engage members remotely.
• Applies Motivational Interviewing and Trauma‑Informed Care principles to build trust.
• Effectively translates clinical information for non‑clinical audiences and actively listens to understand and address needs.

• Member Advocate – Mission Driven.
• Compassionate Care – Identifies and responds to member needs proactively.
• Business Acumen – Applies understanding of government‑funded care to make better recommendations.
• Team Builder – Adapts collaboration style to build understanding and bridge communication gaps.
• Team Effectiveness – Helps improve how the team works together through observations and feedback.
• Engaged Culture – Highlights others’ contributions and drives inclusive actions to contribute to team morale, safety, and engagement.
• Results Driver – Translates broader goals into clear team action, identifies misalignment, and proposes solutions.
• Proactive Approach – Spots gaps or roadblocks early and proposes ways around them.
• Accountability – Uses metrics and data to evaluate impact and refine…