HarmonyCares

Affiliate Manager

• Assist Harmony Cares Primary Care Physician, Nurse Practitioners and Clinical Teams in the delivery of primary health care and patient care management in a residential setting
• Supports mission, vision and core values which include but not limited to delivering compassionate support, attention and assistance to patients, families and members of the team
• Support Patient Care through Clinical Partnership with Nurse Practitioners, Physicians, and Care Management Teams
• Coordinates daily travel itinerary and transports clinicians to scheduled appointments
• Prepares patients for examination and treatment; May at times include preparing patients for minor procedures
• Secures patient consent forms, records patient care documentation accurately and in a timely manner
• Coordinates patient care as directed by Clinicians, company standards and policies
• Respects patient confidentiality at all times and treats patients with courtesy and respect
• Performs phlebotomy (venipuncture only), EKG or any other procedure as requested by Clinician
• Labels, stores and properly packages specimens for lab delivery
• Assists in identifying and closure of quality gaps
• Documentation and updating of patient care plans, as well as SDoH (Social Determinants of Health) and other assessments within the patient chart or electronic medical record
• Prepares and maintains supplies and equipment for treatment (supply inventory, medical bag and car) (where applicable)
• Ensure company vehicle is clean and proper periodic maintenance schedule is followed (where applicable)
• Attends required meetings and in-services

Medical Assistant – Clinical Partner

• Assist Harmony Cares Primary Care Physician, Nurse Practitioners and Clinical Teams in the delivery of primary health care and patient care management in a residential setting
• Supports mission, vision and core values which include but not limited to delivering compassionate support, attention and assistance to patients, families and members of the team
• Support Patient Care through Clinical Partnership with Nurse Practitioners, Physicians, and Care Management Teams
• Coordinates daily travel itinerary and transports clinicians to scheduled appointments
• Prepares patients for examination and treatment; May at times include preparing patients for minor procedures
• Secures patient consent forms, records patient care documentation accurately and in a timely manner
• Coordinates patient care as directed by Clinicians, company standards and policies
• Respects patient confidentiality at all times and treats patients with courtesy and respect
• Performs phlebotomy (venipuncture only), EKG or any other procedure as requested by Clinician
• Labels, stores and properly packages specimens for lab delivery
• Assists In identifying and closure of quality gaps
• Documentation and updating of patient care plans, as well as SDoH (Social Determinants of Health) and other assessments within the patient chart or electronic medical record
• Required to maintain compliance with CLIA (Clinical Laboratory Improvement Amendments), OSHA, and HIPPAA guidelines
• Prepares and maintains supplies and equipment for treatment (supply inventory, medical bag and car) (where applicable)
• Ensure company vehicle is clean and proper periodic maintenance schedule is followed (where applicable)
• Attends required meetings and in-services

Clinical Partner

Risk

• Conduct comprehensive in-home health risk assessments to identify all active and chronic disease conditions, as well as determine all physical, mental, and social needs present at the time of the visit
• Takes history, examines, determines diagnoses.
• Provides written documentation of patient visit, per NCQA standards
• Takes patient vital signs, as necessary.
• Places case management referrals and communicates with PCP as necessary.
• Communicates with patients, caregivers, agency nurses, other providers and vendors as necessary to assure proper diagnosis.
• Performs all clinical duties while observing OSHA Universal Precautions
• Maintains patient confidentiality
• Attends required meetings and in-services and participates in committees, as requested
• Participates in professional development activities and maintains professional licenses and affiliations

Nurse Practitioner, PRN Health Risk Assessments

Bilingual

• Conduct outbound calls to eligible patients and working to facilitate efficient scheduling of initial in-home appointments
• Ensure patients receive a detailed explanation of program services
• Thoroughly and accurately document call notes and scheduling details in electronic system
• Expedite emergency clinical calls as needed
• Process new appointments or changes to existing appointments
• Document accurate and concise patient/family feedback and special needs during each call in our systems, enabling our market-based clinicians to provide excellent care during each appointment
• Must achieve and sustain expected metrics set by department leadership to include but not limited to: Quality Scores, Acceptance Rates, Number of Patients Engaged and Alignment with Harmony Care Core Values
• Demonstrate compassion for individual needs, attention to detail, and collaborating with other team members
• Demonstrate a high level of professionalism and continuous improvement while participating in the call quality monitoring processes
• Utilizes exceptional communication and social skills to clearly explain services and needs to patient/family
• Complete ongoing training and coaching programs for further skills development by deadlines
• Work collaboratively and efficiently with other corporate and market based team members to ensure patients receive exceptional service
• Perform other duties as assigned

Patient Engagement Specialist, Bilingual

• Placing a high volume of outbound calls to secure appointments with a licensed Nurse Practitioner
• Answering incoming calls from members and case managers
• Returning any voice mail messages in a timely manner
• Securing visits via scheduling software efficiently
• Demonstrating excellent customer service skills
• Explaining the importance of completing the annual assessment
• Conducting follow up calls to members prior to scheduled visits
• Confirming and verifying demographic and contact information
• Escalating any problems or concerns associated with field providers to the manager
• Meeting set performance standards and departmental goals

Outreach Specialist I, Bilingual Spanish

Manager

• The Nurse Care Manager is an integral member of the care team and is vital to enhancing the health outcomes of HCMG patients.
• This position will manage a caseload of high-risk patients where he/she is responsible for managing their care and barriers.
• Coordinates care services with pod leader to ensure that patients have access to a comprehensive set of services tailored to their needs throughout their healthcare journey.
• Works collaboratively within the care team to develop and manage personalized care plans, address care gaps, and engage with other resources to ensure access to care.
• Coordinates the transition of care for patients throughout the continuum to ensure patient needs are met accordingly and to ensure that avoidable hospital admissions do not occur.
• Coordinates and facilitates High Risk Huddles along with ensuring that follow-up actions are completed.
• Prioritizes patients based on the severity and urgency of their conditions to ensure that the most critical cases receive immediate attention.
• Reviews medical records to identify gaps in care and coordinate services with the care team to manage these issues.
• Regularly updates patient care plans.
• Performs thorough nursing assessments via telephone of patients to maximize or improve current health outcomes.
• Provides education to patients and/or their caregivers on disease education, medication, health maintenance, and disease prevention to promote self-management and improve health outcomes.
• Demonstrates strong clinical skills, critical thinking abilities, and effective communication in their interactions with patients, caregivers, providers, fellow care team members, etc.
• Documents necessary interactions, assessments, updates, etc. in patient’s medical records according to processes and guidelines.
• Serves as liaison between patients, providers, resources, etc. to ensure seamless care delivery.
• Facilitates communication of patient status and plan of care during transitional experiences such as home to hospital, hospital to post-acute care and back to home.

RN Nurse Care Manager

• Assist Harmony Cares Primary Care Physician, Nurse Practitioners and Clinical Teams in the delivery of primary health care and patient care management in a residential setting
• Supports mission, vision and core values which include but not limited to delivering compassionate support, attention and assistance to patients, families and members of the team
• Support Patient Care through Clinical Partnership with Nurse Practitioners, Physicians, and Care Management Teams
• Coordinates daily travel itinerary and transports clinicians to scheduled appointments
• Prepares patients for examination and treatment; May at times include preparing patients for minor procedures
• Secures patient consent forms, records patient care documentation accurately and in a timely manner
• Coordinates patient care as directed by Clinicians, company standards and policies
• Respects patient confidentiality at all times and treats patients with courtesy and respect
• Performs phlebotomy (venipuncture only), EKG or any other procedure as requested by Clinician
• Labels, stores and properly packages specimens for lab delivery
• Assists in identifying and closure of quality gaps
• Documentation and updating of patient care plans, as well as SDoH (Social Determinants of Health) and other assessments within the patient chart or electronic medical record
• Required to maintain compliance with CLIA (Clinical Laboratory Improvement Amendments), OSHA, and HIPPAA guidelines
• Prepares and maintains supplies and equipment for treatment (supply inventory, medical bag and car) (where applicable)
• Ensure company vehicle is clean and proper periodic maintenance schedule is followed (where applicable)
• Attends required meetings and in-services

Patient Engagement Specialist – Bilingual Portuguese

Analyst

• Develop and maintain provider schedules to meet patient needs.
• Manage provider census through proactive census risk management.
• Manage market census to ensure the right patients are seen at the right time based on HarmonyCares risk tiering and inactivation process.
• Collaborate with local leadership to maximize scheduling system and ensure patient requests are communicated.
• Maintain relationships and effectively communicate HarmonyCares services with patients and family members.
• Place and receive phone calls to facilitate effective scheduling function.
• Escalate scheduling concerns, and issues, both internally and externally
• Adhere to patient confidentiality policies and procedures.
• Attend required meetings and in-services.
• Collaborate with manager, teammates, and other HarmonyCares employees.
• Perform other duties as required.

Scheduling Analyst

Business Development Rep

• The Community Liaison is responsible for inbound/outbound communication and business development.
• The role acts as the local market B2B, B2C, and D2C representative educating community partners and potential patients about the company, our mission and service offerings.
• This role will help facilitate patient transitions of care from area facilities and referral partners to HarmonyCares and will explain the benefits of enrollment to eligible patients and caregivers.
• Market analysis, along with competitive landscape, in which to differentiate HarmonyCares services to external referral partners
• Know and educate the community on our mission to provide high-quality personalized healthcare in the home for people that need it the most
• Meet or exceed agreed upon in person and virtual meeting goals with key decision makers
• Thoroughly understand eligibility and enrollment processes
• Provide education on and facilitate, as requested, benefit enrollment and processes
• Track performance in CRM demonstrating plan and adherence to budgeted targets for a given region
• Schedule face-to-face or phone discussions with patients and their caregivers (or other legal representatives) to provide guidance on patient eligibility for all programs
• For patients interested in being aligned or attributed to an accountable care organization (or other CMS alternative payment model) in which one of the Company’s practices are participating, inform them about the program; and, if they opt to voluntarily align, collect Voluntary Alignment Form from patients (or their legal representatives)
• Answer inbound calls from patients, families, and facility staff members regarding the Company’s business units operating in the relevant market
• Promptly, accurately, professionally triage all patient concerns related to care needs, scheduling and billing to the appropriate department
• Oversee and document outreach calls conducted, and meetings scheduled with external sources
• Adhere to all company policies and procedures and all applicable laws and requirements, including without limitation those related to marketing (including marketing plans), interacting with referral sources and patients, beneficiary notifications, and conducting patient outreach (i.e., calls and in person)
• Comply with HIPAA privacy and security guidelines and company policies, procedures and standards
• Maintain consistent communication with sales leaders and local business unit leadership and support staff
• Performs other additional duties as assigned

Community Liaison – Business Development, Primary Care, Home Health

Salesforce Developer

• Develop customized solutions, including designing, coding and implementing applications within the Salesforce platform that align with business needs and priorities
• Test and monitor the stability and functionality of the application, including troubleshooting and fixing bugs
• Write documents and provide technical training for Salesforce staff
• Maintain the security and integrity of the application software
• Adhere to Salesforce best practices, maintain code documentation, and write/maintain test cases for all custom development
• Take ownership of release cycles to implement and deploy new/updates to existing applications and code
• Collaborating with the Salesforce Team to validate business requirements and any considerations (security, scalability, limits)