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HarmonyCaresPosted 10/19/2026full-timeVirginia Beach • Virginia • United StatesJuniorMid-Level💰 $73,606 - $81,022 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in care management, including Transitional Care Management and Chronic Care Management, while effectively coordinating patient care plans and facilitating communication among healthcare teams. Strong clinical skills and knowledge of Medicare regulations support proactive patient education and care gap closure.
Highest-signal resume keywords
Active Registered Nurse LicenseCare Management ExperienceClinical SkillsKnowledge of Medicare RegulationsPopulation Health Knowledge
About the role
Key responsibilities & impact- Manage a caseload of high-risk patients and their care barriers
- Perform Transitional Care Management, Chronic Care Management, Disease Management Education and Medication Education
- Develop and manage patient care plans
- Serve as co-chair of the pod alongside the pod leader, focusing on prioritizing patient needs
- Coordinate care services to provide comprehensive services throughout patients’ healthcare journeys
- Collaborate with the care team to address care gaps and engage resources
- Coordinate transitions of care and help prevent avoidable hospital admissions
- Coordinate and facilitate High Risk Huddles and ensure follow-up actions are completed
- Prioritize patients based on severity and urgency
- Review medical records to identify gaps in care
- Perform telephone nursing assessments
- Educate patients and caregivers on disease, medication, health maintenance and prevention
- Document interactions, assessments and care-plan updates in medical records
- Liaise between patients, providers and resources
- Facilitate communication of patient status and care plans during transitions between home, hospital and post-acute care
- Work with Executive Directors, Market Leaders, Pod Leaders, Clinical Social Workers, Patient Health Coordinators and the Population Health Team
Requirements
What you’ll need- Active Registered Nurse License
- 2+ years of care management experience in community, health plan or hospital systems
- Possesses strong clinical skills and proactive thinking
- Effective communication skills
- Ability to perform extensive telephone assessment
- Knowledge of Medicare regulations and home care and hospice standards
- Experience with small group presentations and teaching/training
- Exhibits excellent interpersonal skills
- Exhibits excellent written and oral skills
- Working knowledge of computer programs (email, Word, Excel, PowerPoint, etc.)
- Manages time effectively to ensure all duties and documentation requirements are completed in a timely manner
- May be required to obtain multi-state licensing
- Preferred: Bachelor of Science in nursing or related field
- Preferred: Strong knowledge of population health, quality measures, care gap closure and value-based care models
Benefits
Comp & perks- Quarterly Bonuses
- Health, Dental, Vision, Disability & Life Insurance
- 401K Retirement Plan (with company match)
- Tuition, Professional License and Certification Reimbursement
- Paid Time Off, Holidays and Volunteer Time Paid
- Orientation and Training Day Time Hours (no holidays/weekends)
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Transitional Care ManagementChronic Care ManagementDisease Management EducationMedication EducationTelephone Nursing AssessmentsPatient Care PlansDocumentation in Medical RecordsCare Gap ClosureQuality MeasuresValue-Based Care Models
Soft Skills
Effective Communication SkillsInterpersonal SkillsProactive ThinkingTime ManagementTeaching/Training Skills
Tools & Technologies
EmailWordExcelPowerPoint
Certifications & Qualifications
Registered Nurse LicenseMulti-State Licensing (Preferred)
Industry Keywords
High-Risk PatientsCare CoordinationHealthcare JourneysPatient EducationHome Care StandardsHospice Standards