Manage patients assigned to your Care Team, ensuring RN and Interdisciplinary team visit frequencies align with patient's acuity level and needs. Communicate with patients via phone and video conferencing as outlined in the care plan. Provide patient care within your scope of practice and per provider orders. Assess and enroll patients, completing initial referral follow-ups as needed. Develop and update care plans based on ongoing assessments. Manage patient medications, including implementing orders, maintaining current medication lists, assisting with medication refills, and ensuring adequate supply. Provide patient follow-up and education on new medication orders. Facilitate requisition of medical supplies and durable medical equipment. Complete care coordination activities, ensuring timely documentation updates and communication with primary care providers and other physicians. Coordinate with the Interdisciplinary team and external agencies as necessary, including facilitating advanced care planning and hospice referrals. Educate patients and caregivers on Vynca services, disease processes, symptom management, and medication tracking. Assist in covering patient care for other care teams during normal working hours (Float Nurse).