Monogram Health

• Monogram Market Physician Executive (MPE) are mission driven physician leaders who are dedicated to improving the well-being, quality of life, and health outcomes for our patients • The MPE will lead our in-home multi-specialty polychronic care model in an assigned market • The MPE will collaborate with Monogram Health’s Multi-Specialty Platform to leverage employed specialists to deliver in-home specialty care • Aligning with the quadruple AIM, the MPE will focus to improve patient experience, population health outcomes, provider satisfaction and lower costs • The primary goal of each MPE to deliver exceptional outcomes through disease detection and evidence based clinical pathways and disease treatment • Reporting to the Region President, the Market Physician Executive (MPE) is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market • The MPE oversees the daily clinical and business operations through delivery of direct patient care, care management services, social worker support and pharmacy services within the market

• Lead requirements gathering with internal teams, clients, and vendor partners • Create detailed documentation including user stories, functional specs, file specs, and process flows • Support client onboarding and assist with integration requirements and workflow coordination • Develop current- and future-state workflow documentation and process maps • Facilitate implementation readiness activities, including dependency alignment and risk identification • Participate in planning through go-live, supporting UAT, and project documentation • Validate solutions using defined acceptance criteria; conduct basic data validation using Excel/SQL

Title: Care Manager RN Location: Buford, GA, USA Job Description: Job Category: Clinical Requisition Number: CAREM006299 - Full-Time - Hybrid - Locations Showing 1 location Buford, GA Buford, GA, USA Job Details Description Job 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.  Roles and Responsibilities - Work closely with patients’ medical providers to develop and continually adapt care plan - Perform in-home care management visits to execute care management plan - Monitor biometric data and follow approved protocols for any necessary interventions - Inventory and reconcile medications and coordinate with pharmacists and prescribers - Perform patient health assessments and surveys as required - Deliver individual and group education on CKD, ESRD, dialysis and associated comorbidities - Encourage medication and treatment adherence through frequent contact with patients - Engage family and social support groups in the education and care of patients - Serve as the primary point of contact and be the first call when patients have questions (business hours) - Provide education and coaching around medications, medical conditions, diet, exercise, and lifestyle choices - Educate patients and facilitate conversations around proactive care decisions, especially relating to Advance Care Plans and ESRD treatment modalities - Obtain vital signs when visiting patient and escalate any concerns to the provider - Initiate patient relationships through enrolment and onboarding processes - Perform post-op and hospital discharge visits to help patients through vulnerable transitions - Review and document patient updates and progress in care management platform - Coordinate with dialysis providers to ensure transitions of care are seamless Position Requirements - Frequent local travel to perform in-home visits - Basic Life Support (BLS) certification is required in this role. The company will support your certification completion through onboarding - Infrequent domestic travel may be required, primarily to Brentwood, TN for training - Self-starter with the ability to work independently with minimal supervision - Ability to show empathy and quickly build relationships with patients and physicians - Graduate of an accredited School of Nursing - Currently licensed as a Registered Nurse in the State of the posted location - 2+ years previous experience working in care management and/or with CKD/ESRD patients - Ability to take call remotely on some nights and weekends - Excellent verbal communication skills both in person and on the phone - Familiarity with Microsoft Office and mobile phone and web-based applications Benefits - Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts - Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources - Time Off & Leave – Paid holidays, flexible vacation time/PSSL, and paid parental leave - Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts 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. #LI-AW1 Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

• Conduct daily in-person outreach to high-risk, hard-to-reach patients by visiting their homes unannounced and educating them in-person about the Monogram Health program • Proactively schedules and completes at least 15 home visits daily • Drive a designated territory daily to engage new and existing members • Meet or exceed sales targets and KPIs • Facilitate a high completion rate of scheduled visits • Collaborate with internal sales and marketing teams to optimize outreach strategies • Maintain accurate records in CRM systems

• Conduct daily in-person outreach to high-risk, hard-to-reach patients by visiting their homes unannounced and educating them in-person about the Monogram Health program • Proactively schedule and complete at least 15 home visits daily • Drive a designated territory daily to engage new and existing members • Meet or exceed sales targets and KPIs • Facilitate a high completion rate of scheduled visits • Collaborate with internal sales and marketing teams to optimize outreach strategies • Maintain accurate records in CRM systems

• Conduct daily in-person outreach to high-risk, hard-to-reach patients by visiting their homes unannounced and educating them in-person about the Monogram Health program • Proactively schedules and completes at least 15 home visits daily • Drive a designated territory daily to engage new and existing members • Meet or exceed sales targets and KPIs • Facilitate a high completion rate of scheduled visits • Collaborate with internal sales and marketing teams to optimize outreach strategies • Maintain accurate records in CRM systems

• Monogram Market Physician Executive (MPE) are mission driven physician leaders who are dedicated to improving the well-being, quality of life, and health outcomes for our patients. • The MPE will lead our in-home multi-specialty polychronic care model in an assigned market. • Each market is comprised of 5-10 practices led by local advanced practice providers (APP), registered nurses(RN), licensed clinical social workers (LCSW), and pharmacists (PharmD). • Collaborate with Monogram Health’s Multi-Specialty Platform to leverage employed specialists to deliver in-home specialty care. • The primary goal of each MPE to deliver exceptional outcomes through disease detection and evidence based clinical pathways and disease treatment. • Reporting to the Region President, the Market Physician Executive (MPE) is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market. • The MPE oversees the daily clinical and business operations through delivery of direct patient care, care management services, social worker support and pharmacy services within the market. • In support of the advance practice providers the MPE is expected to review and approve care plans and direct the treatment plans for our patients. • The MPE will collaborate with community physicians, facilities, and partners in peer to peer and direct patient care decision making.

• Conduct daily in-person outreach to high-risk, hard-to-reach patients by visiting their homes unannounced and educating them in-person about the Monogram Health program • Proactively schedules and completes at least 15 home visits daily • Drive a designated territory daily to engage new and existing members • Meet or exceed sales targets and KPIs • Facilitate a high completion rate of scheduled visits • Collaborate with internal sales and marketing teams to optimize outreach strategies • Maintain accurate records in CRM systems

• Market Physician Executive (MPE) are mission driven physician leaders who are dedicated to improving the well-being, quality of life, and health outcomes for our patients. • The MPE will lead our in-home multi-specialty polychronic care model in an assigned market. • Collaborate with Monogram Health’s Multi-Specialty Platform to leverage employed specialists to deliver in-home specialty care. • Reporting to the Region President, the MPE is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market. • Oversee the daily clinical and business operations through delivery of direct patient care, care management services, social worker support and pharmacy services within the market. • Actively lead daily high risk and concurrent review rounds. • Direct supervision of front line clinical and operations team members. • Provide direct and indirect patient care (including diagnosis and treatment of disease).

• Conduct daily in-person outreach to high-risk, hard-to-reach patients by visiting their homes unannounced and educating them in-person about the Monogram Health program • Proactively schedules and completes at least 10 home visits daily • Drive a designated territory daily to engage new and existing members • Meet or exceed sales targets and KPIs • Facilitate a high completion rate of scheduled visits • Collaborate with internal sales and marketing teams to optimize outreach strategies • Maintain accurate records in CRM systems