HarmonyCares

Social Worker

• Manage a caseload of high-risk socially complex patients
• Conduct face-to-face and telephonic psychosocial assessments with patients and/or caregivers
• Investigate psychological and social determinant barriers and design appropriate interventions to close gaps in care and needs
• Provide short-term counseling services as needed
• Coordinate services to ensure patients/families understand treatment plans
• Collaborate with the care team to achieve optimal quality and patient experience outcomes, including active participation in High-Risk Huddles
• Provide outreach to community-based services to support patients’ ability to age at home
• Develop and implement shared goals of care with patients and families
• Work with community-based agencies to develop relationships and provide resources supporting patient independence

Licensed Clinical Social Worker

Vice President

• Translate the enterprise population health strategy into measurable improvements in clinical documentation, total cost of care, quality, and patient outcomes
• Define and maintain the enterprise population health strategy, roadmap, and priorities
• Build and lead a high-performing population health function
• Lead strategy for accurate diagnosis, documentation, and management of chronic conditions, including compliant coding
• Partner with Medical Leadership, Market Operations, and Central Operations to improve Stars, HEDIS, preventive care, chronic disease outcomes, and patient experience
• Own the clinical program portfolio, including prioritization, design, governance, and performance management
• Identify cost drivers and develop interventions for high-risk populations, avoidable acute utilization, care transitions, medication-related risk, and chronic disease management
• Establish performance measures and accountability, monitor results, and lead corrective action
• Oversee strategic vendors and external partners
• Represent the organization with health plans, ACO partners, vendors, and other stakeholders
• Partner on continuing medical education session planning
• Participate in Quarterly Operating Reviews and Board of Directors meeting preparation and presentations
• Perform other job-related assignments as requested

Senior VP – Population Health

Analyst

• Analyze and forecast quality performance across measures, contracts, markets, and providers, identifying key trends, risks, and opportunities
• Develop dashboards, analyses, and executive summaries that communicate performance drivers and recommended actions
• Translate CMS, NCQA, and PQA quality measure specifications into clear reporting requirements and monitor relevant program changes
• Validate quality data, including supplemental data submissions, payer reconciliations, and audit support
• Partner with clinical, operational, analytics, technology, and health plan teams to resolve issues and support targeted interventions
• Manage multiple priorities independently and maintain accountability for accurate, timely deliverables
• Report to the Director of Quality Operations
• Perform other duties as assigned

Senior Analyst, Quality Performance

Nurse Practitioner

• Deliver annual risk assessments in residential settings or via telehealth within the Nurse Practitioner scope of practice, as delegated by the Collaborative Physician
• Conduct comprehensive in-home health risk assessments to identify active and chronic disease conditions and determine physical, mental, and social needs
• Take patient history, perform examinations, and determine diagnoses
• Provide written documentation of patient visits per NCQA standards
• Take patient vital signs as necessary
• Place case management referrals and communicate with PCPs as necessary
• Communicate with patients, caregivers, agency nurses, other providers, and vendors to assure proper diagnosis
• Perform clinical duties while observing OSHA Universal Precautions
• Maintain patient confidentiality
• Attend required meetings and in-services and participate in committees as requested
• Participate in professional development activities and maintain professional licenses and affiliations

Nurse Practitioner, PRN

General

• Place a high volume of outbound calls to secure appointments with licensed Nurse Practitioners in members’ homes
• Answer incoming calls from members and case managers and return voicemail messages promptly
• Contact Health Plan members to secure appointments for complete health risk assessments
• Follow talking points and protocols for member outreach calls
• Schedule visits efficiently using scheduling software and available provider capacity
• Explain the importance of completing the annual assessment
• Use up to six software applications simultaneously during calls
• Conduct follow-up calls one business day before scheduled visits
• Confirm and verify demographic and contact information while following HIPAA guidelines
• Verify active insurance status and accurately enter insurance information during patient registration
• Escalate field-provider concerns to the manager
• Meet performance standards, departmental goals, and metrics
• Collaborate with CHA clinical and administrative teams, members, and insurance companies

Outreach Specialist I

Pharmacist

• Provide clinical care to a home-based patient population through a centralized anticoagulation program
• Apply evidence-based medication-use strategies to improve patient and population health outcomes
• Review patient records to identify and resolve potential drug therapy problems
• Optimize, recommend, and prescribe or adjust medications under collaborative practice agreements
• Provide patient and provider education on anticoagulation therapy
• Ensure patient follow-up and monitoring
• Evaluate drug therapy appropriateness and cost-effectiveness
• Communicate with patients, providers, staff, service teammates, and pharmacies
• Optimize anticoagulation workflows and processes
• Maintain adherence to anticoagulation guidelines, policies, and procedures
• Document accurately in the EMR
• Assist with report development and service-metric tracking
• Report adverse drug events and participate in medication quality-improvement activities
• Train practitioners and staff on evidence-based medication practices
• Support clinical, medical, and operations teams with ad hoc projects

Pharmacist – Anticoagulation

Solutions Engineer

• Translate complex healthcare business needs into scalable, production-ready data solutions
• Collaborate with departments to understand user requirements, create technical designs, validate solutions through rapid POCs, and build data assets
• Refine and articulate solution features based on user needs
• Break down complex features, identify risky assumptions, and flag dependencies
• Build and iterate on data pipelines using cloud technologies such as Azure ADF and Databricks
• Design and develop RESTful APIs exposing curated healthcare datasets and analytics products
• Create Power BI/Tableau dashboards and semantic models delivering actionable insights
• Work with claims, clinical, and operational healthcare datasets
• Ingest, transform, and normalize HL7, FHIR, ICD-10, CPT, NDC, and related healthcare vocabularies
• Collaborate with data engineers, data scientists, and analysts to productionize solutions
• Ensure data quality, performance, scalability, and security requirements are met
• Provide technical leadership and mentorship to junior engineers and analysts
• Support stakeholder demos, feedback sessions, and solution walkthroughs
• Collaborate with IT, clinical, operational, vendor, and consulting teams
• Perform other job-related assignments as requested

Senior Solutions Engineer

Trainer

• Develop comprehensive training programs for healthcare professionals, including physicians, nurses, and allied health staff
• Collaborate with subject matter experts to identify training needs and develop learning objectives aligned with organizational goals and regulatory requirements
• Design presentations, e-learning modules, and hands-on workshops
• Deliver in-person workshops, virtual webinars, and on-the-job coaching
• Evaluate training effectiveness through assessments, surveys, and feedback mechanisms
• Continuously improve training programs based on results and participant feedback
• Provide individualized coaching and support to address performance gaps and enhance clinical competencies
• Stay updated on healthcare education and training trends, best practices, and regulatory changes
• Collaborate with HR, Quality Assurance, and Clinical Operations
• Maintain accurate records of training activities, attendance, and outcomes
• Act as a resource and mentor for new hires