Care Concierge LPN

At Home Harmony’s Care Concierge Team is made up of experienced RN, LPN and MA staff who are passionate
about case management and clinical support for our home based medical and pharmacy practice for aging adults.

The Care Concierge RN works with their medical provider, the patients and their family members/caregivers
to provide coordinated case management and medical support from an Office/Remote environment –
a hybrid workplace of company HQ and personal home residence.

Duties and Responsibilities of the Care Concierge:

Clinical Support (Remote via phone)
- Triaging patients over the phone
- Facilitating patient scheduling in EMR
- Recording patient information and data in the EMR
- Manage EMR inbox needs
- Return patient calls and provide consistent communication between medical
  provider, patient, other department leads and external partners.
- Order, track and post results for provider review of diagnostic
  testing
- Order DME
- Monitor remote patient tools such as blood pressure, pulse ox, etc. and
  contact patients based on clinical criteria for abnormal readings
- Other duties as requested
Case Management (Remote via phone)
- This involves talking on the phone, utilization of computer programs such
  as EMR and additional systems, and, periodically, time at senior living communities or riding in
  vehicle to the place of service.
- Create comprehensive and personalized care plans for enrolled
  patients
- Assist patients in transitions of care including hospital discharges, rehab
  admissions/discharges, scheduling follow-up appointments, assisting with home health orders and plan
  of care, and other patient-specific needs
- May be required to complete in-person assessments to set up RPM
  devices
Work with the AHH team of providers and other support staff to provide ongoing
chronic care management to full panel of patients
Provide education regarding disease management risk reduction, strategies and
tactics.
Complete concise, clear, timely documentation in the EMR and supporting software to
meet documentation requirements.
Promote At Home Harmony’s Coordinated Model of Care of Medical and Pharmacy

Job Requirements

5 years’ experience in at least one of the following settings: case management,
disease management, home health care, hospital or outpatient office setting
Experience in Geriatrics, Family Practice, Internal Medicine, Cardiac or Pulmonary
with a passion for working with the Geriatric population
Current unrestricted VA license/certification, required
Current BLS, required
2 years electronic medical record (EMR) experience Athena EMR, preferred
Knowledge of chronic care monitoring/management, preferred
Strong technology skills use of various systems
Strong, professional oral and written communication skills
Outgoing, adaptable and friendly personality
Motivated and flexible in changing needs of the program, team and work environment,
with ability to self-direct in certain prioritization of tasks
Ability to efficiently work remotely and continue to meet productivity
metrics
Knowledge of physician office practice operations, preferred
Valid driver’s license with clean driving record
Ability to lift and carry equipment up to 50 pounds
Ability to walk up and down several flights of stairs easily

At Home Harmony

Launched in 2022, At Home Harmony is an innovative home-based Medical and Pharmacy practice in Richmond,
VA providing exceptional healthcare for aging adults with complex chronic conditions. We are experts in utilizing
Medicare’s comprehensive programming to provide coordinated top-quality care.

If you are seeking a meaningful, flexible opportunity in a team-oriented environment, consider a role with
us. Bring your ideas, knowledge, passion and dedication to our growing team and together we can make a difference in
the lives of our beloved senior population.