Job Description
Nurse Practitioner•Telehealth
TCM / CCM / RPM
Ora Living Richmond, VA Job Details Part-time | Travel nursing $65•$80 an hour 22 hours ago Benefits Flexible schedule Qualifications Collaborate with healthcare professionals Skilled nursing facility experience APRN Care documentation Nurse Practitioner (NP) Telehealth experience Clinical assessment documentation Telehealth platforms Document review Advanced practice provider Telehealth therapy Medical record review for billing accuracy Documentation reviews Post-acute care experience Full Job Description Nurse Practitioner•Transitional Care Management (TCM) Ora Living is seeking a part-time Nurse Practitioner to support our Transitional Care Management program for senior patients in Virginia. This role is primarily focused on post-discharge care for patients returning from the hospital, skilled nursing facility, rehab, or other care setting. The NP will conduct telehealth and occasional in-person follow-up visits, support care transitions, review discharge information, and help ensure patients receive timely clinical follow-up after discharge. This is a hybrid role. Most work may be completed through telehealth and remote clinical review, but the candidate should be willing and able to visit facilities in Virginia when needed. Responsibilities Conduct Transitional Care Management visits for patients after hospital, SNF, or rehab discharge Perform telehealth follow-up visits and occasional in-person visits when clinically or operationally needed Review discharge summaries, diagnoses, medication changes, and care plans Work with Ora's RN and onboarding team to support timely post-discharge follow-up Help ensure patients are contacted and clinically reviewed after discharge Review medication changes and identify potential concerns Assess patient status after discharge, including symptoms, risks, follow-up needs, and care gaps Document visits clearly and in a billing-ready format Coordinate with supervising physician, RN staff, caregivers, facility staff, and other providers Support escalation of urgent clinical concerns when needed Assist with RPM and CCM workflows as the program grows, including reviewing readings, care notes, and follow-up needs Primary Focus The main focus of this role is Transitional Care Management (TCM) . The NP will help Ora build a reliable workflow for patients after discharge: Discharge notification received RN reviews discharge information Patient or caregiver contacted Medication changes reviewed NP completes TCM follow-up visit Documentation completed Care plan and follow-up needs identified This role may also include some support for Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) , but TCM is the initial priority. Requirements Licensed Nurse Practitioner Must be licensed in Virginia or eligible to become licensed in Virginia Experience with senior patients, primary care, geriatrics, post-acute care, home health, assisted living, or skilled nursing preferred Comfortable conducting telehealth visits Comfortable visiting facilities in Virginia when needed Strong clinical documentation skills Ability to review discharge summaries, medications, diagnoses, and care plans Comfortable working with nurses, physicians, caregivers, and facility teams Organized, responsive, and comfortable helping build a new clinical workflow Preferred Experience Transitional Care Management (TCM) Post-discharge follow-up Medicare patients Assisted living or skilled nursing patients Primary care or geriatrics Remote Patient Monitoring (RPM) Chronic Care Management (CCM) Medication reconciliation Telehealth visits Medicare documentation and billing workflows Role Details Part-time Hybrid Virginia-based patients Telehealth visits plus occasional facility visits Flexible schedule $65•80 per hour Opportunity to grow with the program About Ora Living Ora Living provides care coordination, remote patient monitoring, chronic care management, and post-discharge follow-up for senior patients. We work with nurses, physicians, facilities, caregivers, and technology partners to help elderly patients receive better support after discharge and during ongoing care. Our goal is to build a practical clinical workflow that helps patients avoid gaps in care, supports better follow-up, and improves coordination between facilities, families, nurses, and providers. Pay:
$65.00•$80.00 per hour Benefits:
Flexible schedule Work Location:
Hybrid remote in Richmond, VA 23230
