OverviewHarmonyCares is one of the nation’s largest home-based primary care practices. HarmonyCares is a family of companies all dedicated to providing high-quality, coordinated health care in the home. This includes HarmonyCares, HarmonyCares Medical Group, HarmonyCares Home Health and HarmonyCares Hospice.Our Mission – To bring personalized, quality-based healthcare to the home of patients who have difficult accessing care.Our Shared Vision – Every patient deserves access to quality healthcare.Our Values – The way we care is our legacy. Every interaction counts. Go the extra mile. Empower and support each other.Why You Should Want to Work with UsQuarterly BonusesHealth, Dental, Vision, Disability & Life Insurance, and much more401K Retirement Plan (with company match)Tuition, Professional License and Certification ReimbursementPaid Time Off, Holidays and Volunteer Time PaidOrientation and Training Day Time Hours (no holidays/weekends)Great Place to Work CertifiedEstablished in 11 statesLargest home-based primary care practice in the US for over 28 years, making a huge impact in healthcare today!More details about the benefits we offer can be found at https://careers.harmonycares.com/benefits. ResponsibilitiesThe Nurse Care Manager works closely with HarmonyCares Medical Group (HCMG) in home health care continuum and specialty services to maximize the health of the HCMG patients. This position will manage a caseload of high-risk patients where he/she is responsible for managing their care and barriers. These duties will include Transitional Care Management, Chronic Care Management of the HCMG patients.Essential Duties & ResponsibilitiesProvides clinical coordinationPrioritize patients based on the severity and urgency of their conditions. Triage is crucial in high acuity settings to ensure that the most critical cases receive immediate attentionDemonstrate strong clinical skills, critical thinking abilities, and effective communicationPrioritize nursing interventions based on the severity of the patient's conditionCollaborate with the patient and multidisciplinary team to develop an individualized care plan based on the identified goals and needs and allocate tasks and interventions to the appropriate team members based on their experienceCollaborates in patient care planning process to assess, monitor and evaluate options and services to meet health needsImplements a comprehensive clinical care management plan for each patient. Analyses variances from plan and initiates steps to resolve such variancesSpend quality time with our patients and families identifying gaps in care, providing education, and partnering with our continuum in an effort to reduce unplanned hospitalizations and help ensure the right care at the right timeIn this role you may work with. . .Regional Director – Care ManagementProviders, Nurse Practitioners, Physician AssistantsHCPC/Hospice/Home Health StaffClinical LiaisonsHCMG PatientsPatient’s FamiliesCommunity AgenciesCare Givers QualificationsRequired Knowledge, Skills and ExperienceActive R.N. License2 or more years of direct home health experience or care managementAbility to perform extensive telephone assessmentKnowledge of Medicare regulations and home care and hospice standardsMust be self-motivated, independent, structured, organized, very detailed and able to meet deadlinesWorks closely with all providers to include Physicians, Nurse Practitioners (NP), Physician Assistants-(PA) regarding:Criteria for home care referralsCase conferencing to coordinate care, improve documentation and communicationPatient education materialsAssists with documentation to support eligibility of patient under the care of hospice or home care (which may include chart audit worksheet, Labs, diagnostics, History and Physical, Fast Scale, Mortality Risk Scale, etc.*)Participates in developing and enhancing tools and company initiatives that promote patient servicesManages time effectively to ensure all duties and documentation requirements are completed in a timely mannerMaintains communication with the Regional Director - Care Management regarding compliance, job performance and significant patient care issues as they ariseMaintain productivity expectations related to patient visits, telephonic outreach assessments and other duties as assignedPreferred Knowledge, Skills and ExperienceBachelor of ScienceMay be required to obtain multi-state licensing1 year experience of discharge planning1 year leadership and/or supervisory experience Posted Min Pay Rate USD $92,007.00/Yr. Posted Max Pay Rate USD $111,033.00/Yr. Pay TransparencyIndividual compensation packages are based on various factors unique to each candidate, including skill set, experience, qualifications, and other job-related considerations. NoticeHarmonyCares and HarmonyCares Hospice are not affiliated with Harmony Hospice Care. HarmonyCares Hospice does not conduct business in OH. HarmonyCares Hospice conducts business in MI, VA, WI, TX, IN, IL.