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<h3>Job Description</h3>
Job DescriptionJob Description: Nurse Practitioner
Monogram Health is looking for skilled Nurse Practitioners and Physician Assistants eager for the opportunity to make a difference in patients' lives. The Advanced Practitioner at Monogram Health is a key member of an integrated Care Team which includes a Registered Nurse and a Social Worker. The patients we serve often struggle with multiple serious diseases. Our Nurse Practitioners and Physician Assistants help patients improve their quality of life in the home and slow the progression of kidney disease, enabling positive health outcomes.
Your Impact
Using your skills in this position will allow you to deliver personalized compassionate medical care to individuals mainly with CKD and/or ESRD/ESKD. You will also be responsible for caring for patients, maintaining accurate and current patient records and scheduling, and administering follow-up appointments to patients as required. Your gifts as a healthcare professional are urgently needed. In healthcare systems, the patient has too often become secondary due to processes and incentives that don’t positively impact the patient for the long term. Here at Monogram, we strive to change that narrative by putting our patients and their quality of life at the forefront of what we do.
Highlights &amp; Benefits  
<ul>
<li>Flexible scheduling with a hybrid and in-home mode</li>
<li>Value-based care, patient-focused and allows you to spend time with those in your care</li>
<li>Competitive compensation consistent with MGMA guidelines</li>
<li>Comprehensive medical, dental, vision and life insurance</li>
<li>Paid vacation and holiday time</li>
<li>401(k) plan with matching contributions</li>
<li>Paid relocation assistance- location and case dependent</li>
</ul>
Roles and Responsibilities
<ul>
<li>Conducts assessments, which includes comprehensive annual wellness exams on patients both in the patients' home and in the virtual environment </li>
<li>Counsels and educates patients and families about benefits and programs available to help them live healthier lives</li>
<li>Documents items such as: appropriate chief complaint, all applicable diagnosis, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment, and plan</li>
<li>Responsible for the coordination of care with primary care providers, specialists, and appropriate ancillary services</li>
<li>Completes all documentation and paperwork in a timely manner</li>
<li>Maintains quality of care standards as defined by the practice</li>
<li>This position will not be office-based but will be remote in state in which employed and will need to attend periodic training/meetings outside of that state</li>
<li>Deliver evidence-based, timely care in a manner that reduces avoidable hospitalizations, maximizes quality of life, and puts patient health and satisfaction first</li>
<li>Prescribe medications, order tests, and collaborate with patient’s Monogram physician </li>
<li>Perform effectively, as reflected by improved patient quality outcomes, which will be measured and reported daily</li>
<li>Facilitates closing gaps in care by educating patients about preventive monitoring and working with physician practices to schedule diagnostic testing</li>
<li>Assists patients with enrolling to access educational videos</li>
<li>Participates in the integrated care team meetings</li>
<li>Knowledge of disease diagnosis and prevention</li>
<li>Make assessment of patient's health status</li>
<li>Develop treatment plan</li>
<li>Implement a plan consistent with appropriate plan of care</li>
<li>Follow-up and evaluate patient's status</li>
<li>Other duties as assigned  </li>
</ul>
Position Requirements
<ul>
<li>Bilingual (English/Spanish) highly preferred</li>
<li>Basic Life Support (BLS) certification is required in this role. The company will support your certification completion through onboarding. </li>
<li>Active and unrestricted Registered Nurse and Nurse Practitioner or Physician Assistant license</li>
<li>Board certified for appropriate licensure (NP: ANCC/AANP; PA: NCCPA)</li>
<li>Current and unrestricted DEA certificate</li>
<li>Ability to work without direct supervision and practice autonomously</li>
<li>Access to transportation, a valid driver's license, and car insurance</li>
<li>Must be proficient with medical instruments and equipment required by the work</li>
<li>Knowledge of computer-based data management programs and information systems, as well as medical records and point-of-interview technology</li>
<li>Ability to communicate effectively in verbal and written form with retail and medical partners at various levels, patients, family members, physicians and representatives of the community </li>
<li>Sound understanding of all federal and state regulations including HIPAA and OSHA</li>
<li>2 or more years of direct patient care required</li>
<li>Managed Care/IPA/Health Plan experience</li>
<li>Experience conducting annual wellness visits or similar comprehensive visits virtually or in the home </li>
</ul>
About Monogram Health
Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.
Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.
Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.

Nurse Practitioner

<h3>Job Description</h3>
Job DescriptionJob Description: Nurse Practitioner
Monogram Health is looking for skilled Nurse Practitioners and Physician Assistants eager for the opportunity to make a difference in patients' lives. The Advanced Practitioner at Monogram Health is a key member of an integrated Care Team which includes a Registered Nurse and a Social Worker. The patients we serve often struggle with multiple serious diseases. Our Nurse Practitioners and Physician Assistants help patients improve their quality of life in the home and slow the progression of kidney disease, enabling positive health outcomes.
Your Impact
Using your skills in this position will allow you to deliver personalized compassionate medical care to individuals mainly with CKD and/or ESRD/ESKD. You will also be responsible for caring for patients, maintaining accurate and current patient records and scheduling, and administering follow-up appointments to patients as required. Your gifts as a healthcare professional are urgently needed. In healthcare systems, the patient has too often become secondary due to processes and incentives that don’t positively impact the patient for the long term. Here at Monogram, we strive to change that narrative by putting our patients and their quality of life at the forefront of what we do.
Highlights &amp; Benefits  
<ul>
<li>Flexible scheduling with a hybrid and in-home mode</li>
<li>Value-based care, patient-focused and allows you to spend time with those in your care</li>
<li>Competitive compensation consistent with MGMA guidelines</li>
<li>Comprehensive medical, dental, vision and life insurance</li>
<li>Paid vacation and holiday time</li>
<li>401(k) plan with matching contributions</li>
<li>Paid relocation assistance- location and case dependent</li>
</ul>
About Monogram Health
Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.
Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.
Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum. Monogram Health is based in Nashville, Tennessee, operates throughout 37 states, and is privately held by Frist Cressey Ventures, Norwest Venture Partners, TPG Capital, as well as other leading strategic and financial investors. To learn more about Monogram Health, ranked by Inc. Magazine as 2024’s No. 3 fastest growing private company in the United States, please visit here. 
Roles and Responsibilities
<ul>
<li>Conducts assessments, which includes comprehensive annual wellness exams on patients both in the patients' home and in the virtual environment </li>
<li>Counsels and educates patients and families about benefits and programs available to help them live healthier lives</li>
<li>Documents items such as: appropriate chief complaint, all applicable diagnosis, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment, and plan</li>
<li>Responsible for the coordination of care with primary care providers, specialists, and appropriate ancillary services</li>
<li>Completes all documentation and paperwork in a timely manner</li>
<li>Maintains quality of care standards as defined by the practice</li>
<li>This position will not be office-based but will be remote in state in which employed and will need to attend periodic training/meetings outside of that state</li>
<li>Deliver evidence-based, timely care in a manner that reduces avoidable hospitalizations, maximizes quality of life, and puts patient health and satisfaction first</li>
<li>Prescribe medications, order tests, and collaborate with patient’s Monogram physician </li>
<li>Perform effectively, as reflected by improved patient quality outcomes, which will be measured and reported daily</li>
<li>Facilitates closing gaps in care by educating patients about preventive monitoring and working with physician practices to schedule diagnostic testing</li>
<li>Assists patients with enrolling to access educational videos</li>
<li>Participates in the integrated care team meetings</li>
<li>Knowledge of disease diagnosis and prevention</li>
<li>Make assessment of patient's health status</li>
<li>Develop treatment plan</li>
<li>Implement a plan consistent with appropriate plan of care</li>
<li>Follow-up and evaluate patient's status</li>
<li>Other duties as assigned  </li>
</ul>
Position Requirements
<ul>
<li>Bilingual (English/Spanish) highly preferred</li>
<li>Active and unrestricted Registered Nurse and Nurse Practitioner or Physician Assistant license</li>
<li>Board certified for appropriate licensure (NP: ANCC/AANP; PA: NCCPA)</li>
<li>Current and unrestricted DEA certificate</li>
<li>Ability to work without direct supervision and practice autonomously</li>
<li>Access to transportation, a valid driver's license, and car insurance</li>
<li>Must be proficient with medical instruments and equipment required by the work</li>
<li>Knowledge of computer-based data management programs and information systems, as well as medical records and point-of-interview technology</li>
<li>Ability to communicate effectively in verbal and written form with retail and medical partners at various levels, patients, family members, physicians and representatives of the community </li>
<li>Sound understanding of all federal and state regulations including HIPAA and OSHA</li>
<li>2 or more years of direct patient care required</li>
<li>Managed Care/IPA/Health Plan experience</li>
<li>Experience conducting annual wellness visits or similar comprehensive visits virtually or in the home </li>
</ul>

Nurse Practitioner- Kenner, LA

<h3>Job Description</h3>
Job DescriptionJob Description: Care Manager – Registered Nurse
Monogram Health is looking for skilled Registered Nurse eager for the opportunity to make a difference in patients' lives. The Care Manager RN is a key member of an integrated Care Team which includes an Advanced Practice Provider and a Social Worker. The patients we serve often struggle with multiple serious diseases. Registered Nurses help patients improve their quality of life in the home and slow the progression of kidney disease, enabling positive health outcomes.
Your Impact:
As a Registered Nurse, you are an integral part of building trusting relationships with patients, so that they can experience a high quality of life at home. Work with a small panel of patients where you can directly experience the impact of your care. In healthcare systems, the patient has too often become secondary due to processes and incentives that don’t positively impact the patient for the long term. Here at Monogram, we strive to change that narrative by putting our patients and their quality of life at the forefront of what we do. 
Highlights &amp; Benefits  
<ul>
<li>Flexible scheduling with a hybrid and in-home model</li>
<li>Competitive compensation and a performance-based bonus program</li>
<li>Full benefits package including medical, dental, vision, life insurance, 401(k) plan with matching contributions, paid vacation and holiday time</li>
</ul>
Roles and Responsibilities
<ul>
<li>Work closely with patients’ medical providers to develop and continually adapt care plan</li>
<li>Perform in-home care management visits to execute care management plan</li>
<li>Monitor biometric data and follow approved protocols for any necessary interventions</li>
<li>Inventory and reconcile medications and coordinate with pharmacists and prescribers</li>
<li>Perform patient health assessments and surveys as required</li>
<li>Deliver individual and group education on CKD, ESRD, dialysis and associated comorbidities</li>
<li>Encourage medication and treatment adherence through frequent contact with patients</li>
<li>Engage family and social support groups in the education and care of patients</li>
<li>Serve as the primary point of contact and be the first call when patients have questions (business hours)</li>
<li>Provide education and coaching around medications, medical conditions, diet, exercise, and lifestyle choices</li>
<li>Educate patients and facilitate conversations around proactive care decisions, especially relating to Advance Care Plans and ESRD treatment modalities</li>
<li>Obtain vital signs when visiting patient and escalate any concerns to the provider</li>
<li>Initiate patient relationships through enrolment and onboarding processes</li>
<li>Perform post-op and hospital discharge visits to help patients through vulnerable transitions</li>
<li>Review and document patient updates and progress in care management platform</li>
<li>Coordinate with dialysis providers to ensure transitions of care are seamless</li>
</ul>
Position Requirements
<ul>
<li>Frequent local travel to perform in-home visits</li>
<li>Basic Life Support (BLS) certification is required in this role. The company will support your certification completion through onboarding</li>
<li>Infrequent domestic travel may be required, primarily to Brentwood, TN for training</li>
<li>Self-starter with the ability to work independently with minimal supervision</li>
<li>Ability to show empathy and quickly build relationships with patients and physicians</li>
<li>Graduate of an accredited School of Nursing</li>
<li>Currently licensed as a Registered Nurse in the State of the posted location</li>
<li>2+ years previous experience working in care management and/or with CKD/ESRD patients</li>
<li>Ability to take call remotely on some nights and weekends</li>
<li>Excellent verbal communication skills both in person and on the phone</li>
<li>Familiarity with Microsoft Office and mobile phone and web-based applications</li>
</ul>
About Monogram Health
Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.
Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.
Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum. .

Care Manager - Registered Nurse

<h3>Job Description</h3>
Job DescriptionJob Description: Care Manager, Social Worker
Monogram Health is looking for skilled Social Worker eager for the opportunity to make a difference in patients' lives. The Care Manager Social Worker is a key member of an integrated Care Team which includes a Nurse Care Manager and an Advanced Practice Provider. The patients we serve often struggle with multiple serious diseases and behavioral health challenges. Social workers can remove the many economic and behavioral barriers to patients, enabling positive health outcomes. 
Your Impact 
The care team works with patients face-to-face, over the phone, and through telehealth to identify and address social determinants of health. The goal is to build a patient’s social support network, navigate behavioral challenges, and generally help patients through a traumatic diagnosis and life-changing disease. Your gifts as a healthcare professional are urgently needed. In healthcare systems, the patient has too often become secondary due to processes and incentives that don’t positively impact the patient for the long term. Here at Monogram, we strive to change that narrative by putting our patients and their quality of life at the forefront of what we do.  
Highlights &amp; Benefits    
<ul>
<li>Remote opportunity with some occasional local travel</li>
<li>The ability to work directly with patients and build meaningful relationships</li>
<li>Full benefits package including medical, dental, vision, life insurance, 401(k) plan with matching contributions, paid vacation and holiday time</li>
</ul>
Roles and Responsibilities
<ul>
<li>Perform in-home and telehealth care management visits to assess and determine social and behavioral status </li>
<li>Work closely with Care Team to ensure collaboration and optimal patient outcomes</li>
<li>Assess social determinants of health needs and develop a plan for addressing them</li>
<li>Identify, vet, and build relationships with local Community-Based Organizations </li>
<li>Educate patients on appropriate resources, assist with referral completion, and follow up for closure outcomes</li>
<li>Serve as subject matter expert on social determinants for other members of the Care Team </li>
<li>Complete behavioral, environmental, and social support assessments</li>
<li>Deliver individual, family and group education on living with chronic illness </li>
<li>Engage family and social support groups in the education and care of patients </li>
<li>Assess patients and refer to behavioral health specialists if diagnosis and treatment needed </li>
<li>Help patients to understand, accept and follow medical and lifestyle recommendations </li>
<li>Review and document patient updates and progress in care management platform </li>
</ul>
Position Requirements 
<ul>
<li>This position involves telephonic visits with some car travel to patients’ homes </li>
<li>Basic Life Support (BLS) certification is required in this role. The company will support your certification completion through onboarding. </li>
<li>Currently licensed as a LCSW or LMSW in the posted state </li>
<li>Master’s degree in social work and passed ASWB masters or clinical exam</li>
<li>Rare domestic travel may be required to Brentwood, TN </li>
<li>Self-starter with the ability to work independently with minimal supervision </li>
<li>Ability to show empathy and quickly build relationships with patients and local CBOs </li>
<li>Preferred 2+ years previous experience working in care management and/or with chronic illness </li>
<li>Excellent verbal communication skills both in person and on the phone </li>
<li>Familiarity with Microsoft Office and mobile phone and web-based applications </li>
</ul>
About Monogram Health 
Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.
Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.
Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum. Monogram Health is based in Nashville, Tennessee, operates throughout 37 states, and is privately held by Frist Cressey Ventures, Norwest Venture Partners, TPG Capital, as well as other leading strategic and financial investors. To learn more about Monogram Health, ranked by Inc. Magazine as 2024’s No. 3 fastest growing private company in the United States, please visit here.

Care Manager - Social Worker - Greenville, SC

<h3>Job Description</h3>
Job DescriptionPosition: Palliative Care Nurse Practitioner 
Monogram Health is seeking a full-time Palliative Care Advanced Practice Provider (APP) to join the team to support our rapid nationwide growth. This Palliative Care APP will be an in-market provider delivering in-home care for a highly complex patient population in their community, including end-of-life patients with CKD/ESRD, diabetes, COPD, and CHF. The Palliative Care APP will support the Market Physician Executive, the Palliative Care Lead Physician, and an interdisciplinary team to provide palliative care, clinical guidance to patients and their families, including pain and symptom management, develop appropriate care plans and document advance directives to ensure patient-centered care.
Your Impact
Palliative Care APPs are quality-driven clinicians who apply their expertise in a managed care, population health context. They also engage in population health management in a sophisticated, outcomes-driven manner that promotes palliative care where clinically appropriate and focuses on patient quality of life, education, and shared-decision making. 
They will collaborate with our interdisciplinary Pod teams and field clinicians to enhance care integration and optimize palliative care delivery to complex patients through Monogram Health’s comprehensive polychronic care model.
Highlights &amp; Benefits 
<ul>
<li>Flexible scheduling</li>
<li>Opportunity to work in a dynamic, fast-paced and innovative organization that is transforming the delivery of polychronic disease care </li>
<li>Competitive salary plus company bonus program </li>
<li>Full benefits including medical, dental, vision and life insurance </li>
<li>Paid time off and 401(k) with matching contributions</li>
</ul>
Roles &amp; Responsibilities 
<ul>
<li>Collaborate with the Market Physician Executive and clinical leaders including Palliative Care physician to proactively identify patients who qualify for palliative care services and build a patient panel</li>
<li>Develop individualized care plans in collaboration with Market Physician Executive and other clinical leaders including Palliative Care physician to ensure patients are placed on appropriate evidence-based interventions and pathways</li>
<li>Provide compassionate, patient-centric palliative care primarily through in-home visits, with virtual care as needed, to support outcomes and care in alignment with patient’s goals</li>
<li>Evaluate and treat symptoms that may interfere with quality of life, like pain, pruritus, depression, anxiety, insomnia, etc. </li>
<li>Collaborate with pharmacists and other clinicians to manage medication panels for complex patients  </li>
<li>Provide resources and educate patients and their families on the progression of CKD, ESKD, and related conditions, including treatment options and palliative care principles</li>
<li>Help families navigate complex medical decisions and improve understanding of prognosis, including advance care planning to discuss values, goals of care, and document patient/family wishes in state AD/POLST forms </li>
<li>Deliver evidence-based, timely care in a manner that reduces avoidable hospitalizations, maximizes quality of life, and puts patient health and satisfaction first </li>
<li>Support patients utilizing our interdisciplinary team, including Palliative Care Chaplain</li>
<li>Assist with transition to hospice care as appropriate </li>
<li>Participate in monthly meetings with clinical leadership to drive Program KPIs and support execution of clinical and financial goals</li>
<li>Educate and support team members on palliative care, hospice care, advance directives, symptom assessment, and communication</li>
<li>As needed for patient care, conducts assessments, which includes comprehensive annual wellness exams on patients both in the patients' home and in the virtual environment </li>
<li>Counsels and educates patients and families about benefits and programs available to help them live healthier lives </li>
<li>Documents items such as: appropriate chief complaint, all applicable diagnosis, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment, and plan. Completes all documentation and paperwork in a timely manner </li>
<li>Responsible for the coordination of care with primary care providers, specialists, and appropriate ancillary services </li>
<li>This position will not be office-based but will be remote in state in which employed and will need to attend periodic training/meetings outside of that state </li>
<li>Prescribe medications, order tests, and collaborate with patient’s Monogram physician </li>
<li>Perform effectively, as reflected by improved patient quality outcomes, which will be measured and reported daily </li>
<li>Facilitates closing gaps in care by educating patients about preventive monitoring and working with physician practices to schedule diagnostic testing </li>
<li>Assists patients with enrolling to access educational videos </li>
<li>Participates in the integrated care team meetings </li>
<li>Make assessment of patient's health status and develop treatment plan </li>
<li>Implement a plan consistent with patient’ goals of appropriate plan of care </li>
<li>Follow-up and evaluate patient's status </li>
<li>Other duties as assigned </li>
</ul>
Minimum Qualifications
<ul>
<li>Active and unrestricted Nurse Practitioner or Physician Assistant license </li>
<li>Board certified for appropriate licensure (NP: ANCC/AANP; PA: NCCPA) </li>
<li>Current and unrestricted DEA certificate </li>
<li>Ability to work without direct supervision and practice autonomously </li>
<li>Must possess reliable transportation and the ability to travel within the designated region to meet patient needs including in-home and clinic visits as needed. Access to transportation, a valid driver's license, and car insurance </li>
<li>Active state-specific licensure and willingness to become licensed in multiple states as company and patient needs require</li>
<li>2+ years working with patients in a palliative care setting; other relevant experience will be considered</li>
</ul>
Preferred Qualifications
<ul>
<li>Is certified in ACHPN or CHPN</li>
<li>Demonstrated experience in clinical assessment, care plan design, and evaluating patients using evidence-based clinical criteria </li>
<li>Strong communication skills for sensitive conversations about prognosis and end-of life decisions including goals of care discussions and advance care planning</li>
<li>Proficiency with electronic health record (EHR) systems to document complex case details</li>
</ul>
 About Monogram Health:
Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders. 
Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.
Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.

Palliative Nurse Practitioner

<h3>Job Description</h3>
Job DescriptionJob Description: Care Manager – Registered Nurse
Monogram Health is looking for skilled Registered Nurse eager for the opportunity to make a difference in patients' lives. The Care Manager RN is a key member of an integrated Care Team which includes an Advanced Practice Provider and a Social Worker. The patients we serve often struggle with multiple serious diseases. Registered Nurses help patients improve their quality of life in the home and slow the progression of kidney disease, enabling positive health outcomes.
Your Impact:
As a Registered Nurse, you are an integral part of building trusting relationships with patients, so that they can experience a high quality of life at home. Work with a small panel of patients where you can directly experience the impact of your care. In healthcare systems, the patient has too often become secondary due to processes and incentives that don’t positively impact the patient for the long term. Here at Monogram, we strive to change that narrative by putting our patients and their quality of life at the forefront of what we do. 
Highlights &amp; Benefits  
<ul>
<li>Flexible scheduling with a hybrid and in-home model</li>
<li>Competitive compensation and a performance-based bonus program</li>
<li>Full benefits package including medical, dental, vision, life insurance, 401(k) plan with matching contributions, paid vacation and holiday time</li>
</ul>
Roles and Responsibilities
<ul>
<li>Work closely with patients’ medical providers to develop and continually adapt care plan</li>
<li>Perform in-home care management visits to execute care management plan</li>
<li>Monitor biometric data and follow approved protocols for any necessary interventions</li>
<li>Inventory and reconcile medications and coordinate with pharmacists and prescribers</li>
<li>Perform patient health assessments and surveys as required</li>
<li>Deliver individual and group education on CKD, ESRD, dialysis and associated comorbidities</li>
<li>Encourage medication and treatment adherence through frequent contact with patients</li>
<li>Engage family and social support groups in the education and care of patients</li>
<li>Serve as the primary point of contact and be the first call when patients have questions (business hours)</li>
<li>Provide education and coaching around medications, medical conditions, diet, exercise, and lifestyle choices</li>
<li>Educate patients and facilitate conversations around proactive care decisions, especially relating to Advance Care Plans and ESRD treatment modalities</li>
<li>Obtain vital signs when visiting patient and escalate any concerns to the provider</li>
<li>Initiate patient relationships through enrolment and onboarding processes</li>
<li>Perform post-op and hospital discharge visits to help patients through vulnerable transitions</li>
<li>Review and document patient updates and progress in care management platform</li>
<li>Coordinate with dialysis providers to ensure transitions of care are seamless</li>
</ul>
Position Requirements
<ul>
<li>Frequent local travel to perform in-home visits</li>
<li>Basic Life Support (BLS) certification is required in this role. The company will support your certification completion through onboarding</li>
<li>Infrequent domestic travel may be required, primarily to Brentwood, TN for training</li>
<li>Self-starter with the ability to work independently with minimal supervision</li>
<li>Ability to show empathy and quickly build relationships with patients and physicians</li>
<li>Graduate of an accredited School of Nursing</li>
<li>Currently licensed as a Registered Nurse in the State of the posted location</li>
<li>2+ years previous experience working in care management and/or with CKD/ESRD patients</li>
<li>Ability to take call remotely on some nights and weekends</li>
<li>Excellent verbal communication skills both in person and on the phone</li>
<li>Familiarity with Microsoft Office and mobile phone and web-based applications</li>
</ul>
About Monogram Health:
Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.
Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.
Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum. Monogram Health is based in Nashville, Tennessee, operates throughout 37 states, and is privately held by Frist Cressey Ventures, Norwest Venture Partners, TPG Capital, as well as other leading strategic and financial investors. To learn more about Monogram Health, ranked by Inc. Magazine as 2024’s No. 3 fastest growing private company in the United States, please visit here.

<h3>Job Description</h3>
Job Description
Job Summary:
Carrillo Surgery Center (CSC) has an opening for a Director of Nursing. A state-of-the-art facility located in beautiful Santa Barbara, CSC is a AAAHC accredited and Medicare certified outpatient surgery center specializing in spine, pain management, and neurology. The position will be responsible for the overall operations at CSC, and will direct, coordinate, and control all aspects of CSC’s clinical operations to ensure the highest quality of patient care. Working closely with the Administrator, the Director of Nursing will oversee preventive safety measures and risk management duties, and use their clinical and leadership experience to enhance patient care and improve clinical outcomes.
Job Duties: 
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Supervise nursing and support staff, ensuring efficient operations and patient safety.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Develop and maintain clear policies and procedures.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Spearhead quality improvement and risk management.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Oversee medical management, including quality of care, safety programs, and compliance.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Participate in Human Resources processes, including hiring/interviewing.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Governance
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Provide personnel with clinical training and opportunities for continuous development.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Check daily staffing and assure staffing needs are addressed, including coordinating anesthesia coverage and staff schedules.
Skills and Qualifications:
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Minimum of three years of experience managing a freestanding ambulatory surgery center or surgery department preferred.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; RN – Current and valid Registered Nurse license to work within the State of California required.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Bachelor’s degree in nursing – Associate’s (required)/Bachelor’s (preferred)
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; BLS – Current Basic Life Support (BLS) for Healthcare Providers by American Heart Association (AHA) required.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ACLS – Advanced Cardiac Life Support Certification required.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Previous experience in leading or being a part of the ASC Accreditation process preferred.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Working knowledge of CMS, California state/federal laws, OSHA, HIPAA, and AAAHC.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Ability to work well in a fast-paced environment, and simultaneously coordinate multiple activities.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Strong interpersonal and communication skills with the ability to collaborate with a large number of team members.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Strong organization and writing skills.
·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Good analytical, decision-making, and critical thinking skills.
Ability to recognize and maintain confidentiality.
Company DescriptionCarrillo Surgery Center is a state-of-the-art surgical facility located in Santa Barbara. Our mission since 2005 has been to provide our community with a premier multispecialty surgical facility. We combine a friendly and caring environment with highly skilled physicians to provide the highest level of care. Carrillo Surgery center is accredited by the American Association of Ambulatory Health Care (AAAHC), and certified by Medicare. 
<h3>Company Description</h3>
Carrillo Surgery Center is a state-of-the-art surgical facility located in Santa Barbara. Our mission since 2005 has been to provide our community with a premier multispecialty surgical facility. We combine a friendly and caring environment with highly skilled physicians to provide the highest level of care. Carrillo Surgery center is accredited by the American Association of Ambulatory Health Care (AAAHC), and certified by Medicare.

Director of Nursing

<h3>Job Description</h3>
Job DescriptionPosition: Palliative Care Nurse Practitioner - Houston, TX
Monogram Health is seeking a full-time Palliative Care Advanced Practice Provider (APP) to join the team to support our rapid nationwide growth. This Palliative Care APP will be an in-market provider delivering in-home care for a highly complex patient population in their community, including end-of-life patients with CKD/ESRD, diabetes, COPD, and CHF. The Palliative Care APP will support the Market Physician Executive, the Palliative Care Lead Physician, and an interdisciplinary team to provide palliative care, clinical guidance to patients and their families, including pain and symptom management, develop appropriate care plans and document advance directives to ensure patient-centered care.
Your Impact
Palliative Care APPs are quality-driven clinicians who apply their expertise in a managed care, population health context. They also engage in population health management in a sophisticated, outcomes-driven manner that promotes palliative care where clinically appropriate and focuses on patient quality of life, education, and shared-decision making. 
They will collaborate with our interdisciplinary Pod teams and field clinicians to enhance care integration and optimize palliative care delivery to complex patients through Monogram Health’s comprehensive polychronic care model.
Highlights &amp; Benefits 
<ul>
<li>Flexible scheduling</li>
<li>Opportunity to work in a dynamic, fast-paced and innovative organization that is transforming the delivery of polychronic disease care </li>
<li>Competitive salary plus company bonus program </li>
<li>Full benefits including medical, dental, vision and life insurance </li>
<li>Paid time off and 401(k) with matching contributions</li>
</ul>
Roles &amp; Responsibilities 
<ul>
<li>Collaborate with the Market Physician Executive and clinical leaders including Palliative Care physician to proactively identify patients who qualify for palliative care services and build a patient panel</li>
<li>Develop individualized care plans in collaboration with Market Physician Executive and other clinical leaders including Palliative Care physician to ensure patients are placed on appropriate evidence-based interventions and pathways</li>
<li>Provide compassionate, patient-centric palliative care primarily through in-home visits, with virtual care as needed, to support outcomes and care in alignment with patient’s goals</li>
<li>Evaluate and treat symptoms that may interfere with quality of life, like pain, pruritus, depression, anxiety, insomnia, etc. </li>
<li>Collaborate with pharmacists and other clinicians to manage medication panels for complex patients  </li>
<li>Provide resources and educate patients and their families on the progression of CKD, ESKD, and related conditions, including treatment options and palliative care principles</li>
<li>Help families navigate complex medical decisions and improve understanding of prognosis, including advance care planning to discuss values, goals of care, and document patient/family wishes in state AD/POLST forms </li>
<li>Deliver evidence-based, timely care in a manner that reduces avoidable hospitalizations, maximizes quality of life, and puts patient health and satisfaction first </li>
<li>Support patients utilizing our interdisciplinary team, including Palliative Care Chaplain</li>
<li>Assist with transition to hospice care as appropriate </li>
<li>Participate in monthly meetings with clinical leadership to drive Program KPIs and support execution of clinical and financial goals</li>
<li>Educate and support team members on palliative care, hospice care, advance directives, symptom assessment, and communication</li>
<li>As needed for patient care, conducts assessments, which includes comprehensive annual wellness exams on patients both in the patients' home and in the virtual environment </li>
<li>Counsels and educates patients and families about benefits and programs available to help them live healthier lives </li>
<li>Documents items such as: appropriate chief complaint, all applicable diagnosis, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment, and plan. Completes all documentation and paperwork in a timely manner </li>
<li>Responsible for the coordination of care with primary care providers, specialists, and appropriate ancillary services </li>
<li>This position will not be office-based but will be remote in state in which employed and will need to attend periodic training/meetings outside of that state </li>
<li>Prescribe medications, order tests, and collaborate with patient’s Monogram physician </li>
<li>Perform effectively, as reflected by improved patient quality outcomes, which will be measured and reported daily </li>
<li>Facilitates closing gaps in care by educating patients about preventive monitoring and working with physician practices to schedule diagnostic testing </li>
<li>Assists patients with enrolling to access educational videos </li>
<li>Participates in the integrated care team meetings </li>
<li>Make assessment of patient's health status and develop treatment plan </li>
<li>Implement a plan consistent with patient’ goals of appropriate plan of care </li>
<li>Follow-up and evaluate patient's status </li>
<li>Other duties as assigned </li>
</ul>
Minimum Qualifications
<ul>
<li>Active and unrestricted Nurse Practitioner or Physician Assistant license </li>
<li>Board certified for appropriate licensure (NP: ANCC/AANP; PA: NCCPA) </li>
<li>Current and unrestricted DEA certificate </li>
<li>Ability to work without direct supervision and practice autonomously </li>
<li>Must possess reliable transportation and the ability to travel within the designated region to meet patient needs including in-home and clinic visits as needed. Access to transportation, a valid driver's license, and car insurance </li>
<li>Active state-specific licensure and willingness to become licensed in multiple states as company and patient needs require</li>
<li>2+ years working with patients in a palliative care setting; other relevant experience will be considered</li>
</ul>
Preferred Qualifications
<ul>
<li>Is certified in ACHPN or CHPN</li>
<li>Demonstrated experience in clinical assessment, care plan design, and evaluating patients using evidence-based clinical criteria </li>
<li>Strong communication skills for sensitive conversations about prognosis and end-of life decisions including goals of care discussions and advance care planning</li>
<li>Proficiency with electronic health record (EHR) systems to document complex case details</li>
</ul>
 About Monogram Health:
Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders. 
Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.
Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum. Monogram Health is based in Nashville, Tennessee, operates throughout 37 states, and is privately held by Frist Cressey Ventures, Norwest Venture Partners, TPG Capital, as well as other leading strategic and financial investors. To learn more about Monogram Health, ranked by Inc. Magazine as 2024’s No. 3 fastest growing private company in the United States, please visit here.

Palliative Advanced Practice Provider

<h3>Job Description</h3>
Job DescriptionBenefits: 
<ul>
<li>Student Loan Repayment</li>
<li>Employee Assistance Program</li>
<li>AFLAC</li>
<li>10.5 Paid Holidays</li>
<li>Sick Time</li>
<li>Vacation Time</li>
<li>Disability and Life Insurance</li>
<li>Medical, Dental, and Behavioral Health Service Discounts</li>
<li>401(k) matching</li>
<li>Competitive salary</li>
<li>Dental insurance</li>
<li>Health insurance</li>
<li>Vision insurance</li>
</ul>
 Horizon Health in Aberdeen, SD is seeking a Full TimeRegistered Nurse, Licensed Practical Nurse or Certified Medical Assistant to provide nursing care to patients in an outpatient clinic setting. We are looking for candidates who are passionate about delivering high-quality, patient-centered care. Horizon Health offers a collaborative, team-oriented work environment focused on meeting the needs of individual patients while supporting and contributing to the health and wellness of our communities. *Must have a valid SD Nursing License. *Medical Assistants must be certified through an accredited program. Key Responsibilities: 
<ul>
<li>Coordinate care for patients through entire patient visit including rooming patients and doing vitals, collecting adequate history and updating medications, updating all patient clinical information in EHR, preparing the patient for the provider visit, scheduling follow-up care as needed, and cleaning/stocking the room.</li>
<li>Provide patient education including but not limited to patient overall health management, initiation of referral management for the patient care, care coordination for preventative and specialty visits and development of care plans including self-management plans and goal initiation.</li>
<li>Initiate and perform nursing skills (as per scope of license) including injections as ordered by provider, vaccinations, labs, x-rays and other tests. On the Job training for labs and x-rays. </li>
</ul>
 Our Culture: Horizon Healths culture is built on the Non-Negotiable attributes of Respect, Teamwork, Accountability, Integrity, Professionalism, and being Rurally Focused ensuring every team member upholds these attributes daily. The organization values all contributions equally, supports individual growth, and aims to be your "forever employer" that enhances both employee satisfaction and community health outcomes.

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