NP Full-time
Monogram Health

Advanced Practice Provider- Anderson, SC

Position: 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. Monogram Health is a leading multispecialty provider of in-home, evidence-based care and benefit management services for the most complex of patients who have multiple chronic conditions 

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. 

Responsibilities   

  • Conducts assessments, which includes comprehensive annual wellness exams on patients both in the patients' home and in the virtual environment
  • Counsels and educates patients and families about benefits and programs available to help them live healthier lives
  • 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
  • Responsible for the coordination of care with primary care providers, specialists, and appropriate ancillary services
  • Completes all documentation and paperwork in a timely manner
  • Maintains quality of care standards as defined by the practice
  • 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
  • Deliver evidence-based, timely care in a manner that reduces avoidable hospitalizations, maximizes quality of life, and puts patient health and satisfaction first  
  • Prescribe medications, order tests, and collaborate with patient’s Monogram physician
  • Perform effectively, as reflected by improved patient quality outcomes, which will be measured and reported daily
  • Facilitates closing gaps in care by educating patients about preventive monitoring and working with physician practices to schedule diagnostic testing
  • Assists patients with enrolling to access educational videos
  • Participates in the integrated care team meetings
  • Knowledge of disease diagnosis and prevention
  • Make assessment of patient's health status
  • Develop treatment plan
  • Implement a plan consistent with appropriate plan of care
  • Follow-up and evaluate patient's status
  •  Other duties as assigned  

 

Position Requirements     

  • Active and unrestricted Registered Nurse and Nurse Practitioner or Physician Assistant license
  • Board certified for appropriate licensure (NP: ANCC/AANP; PA: NCCPA)
  • Current and unrestricted DEA certificate
  • Ability to work without direct supervision and practice autonomously
  • Access to transportation, a valid driver's license, and car insurance
  • Must be proficient with medical instruments and equipment required by the work
  • Knowledge of computer-based data management programs and information systems, as well as medical records and point-of-interview technology
  • 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
  • Sound understanding of all federal and state regulations including HIPAA and OSHA   
  • 2 or more years of direct patient care required
  • Managed Care/IPA/Health Plan experience
  • Experience conducting annual wellness visits or similar comprehensive visits virtually or in the home

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  

  • Earn a competitive base salary 
  • Grow your clinical skillset and earn $2,500 for every core and specialty competency you complete
  • Invest in your longevity with a $5,000 annual anniversary bonus
  • Maximize your income potential with up to 15% in additional bonuses, including:
    • Quarterly bonuses for quality, patient experience, and chronic condition outcomes
    • Annual bonuses for visit cadence, wellness performance, and patient engagement
    • A company‑wide 5% annual kicker bonus
  • Start earning bonuses sooner — eligibility begins after just 3 months

 

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-SJ1

Share this job

Share to FB Share to LinkedIn Share to Twitter

Related Jobs

Conviva Senior Primary Care

Nurse Practitioner / Physician Assistant

Become a part of our caring community and help us put health first Join a Team That’s Redefining Senior Primary Care Humana’s Primary Care Organization is one of the largest and fastest-growing senior-focused, value-based care providers in the country. With over 340 centers across 15 states operating under the CenterWell and Conviva brands, we’re transforming healthcare by putting seniors at the heart of everything we do. As a Nurse Practitioner (NP) or Physician Assistant (PA) at CenterWell Senior Primary Care , you’ll be part of a collaborative, multidisciplinary team that includes physicians, pharmacists, care coaches, behavioral health specialists, and more—all working together to deliver personalized, high-quality care. We’re not just improving healthcare—we’re improving lives. That includes yours. Why You’ll Love Working Here Team-Based Care Model : Work alongside a dedicated care team that supports patients’ physical, emotional, and social wellness. More Time with Patients : See fewer patients per day and spend more time delivering meaningful care. Supportive Culture : We foster a welcoming, inclusive environment where teamwork and growth are prioritized. Work-Life Balance : Enjoy generous PTO, minimal call responsibilities, and CME time. Your Role & Responsibilities Provide comprehensive care to seniors in accordance with clinical standards. Collaborate daily with your care team to ensure coordinated, high-quality care. Manage referrals, hospital/SNF coordination, DME, and home health services. Participate in daily huddles. CAs tend to lead the huddles Document care accurately and efficiently with support from quality-based coders. Participate in on-call rotation and support growth initiatives at your center. Ensure compliance with all licensing and accreditation requirements. What We’re Looking For Required: Master’s Degree in Nursing or completion of a PA program with board certification. Active, unrestricted NP or PA license in the state of practice. Strong communication and interpersonal skills. Passion for value-based care and integrated team-based models. Basic computer proficiency (EMR, email, etc.). Use your skills to make an impact Preferred: Experience in value-based care, primary care or Medicare Advantage settings. Active DEA license and Medicare/Medicaid provider numbers or ability to obtain DEA license and/or Medicaid and Medicare numbers Familiarity with HEDIS quality indicators and Medicare guidelines. Compensation & Benefits Competitive base salary + annual bonus Health insurance effective Day 1 401(k) with employer match CME allowance + dedicated CME time Occurrence-based malpractice coverage Life & disability insurance Generous PTO & paid holidays Minimal call responsibilities Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $115,200 - $158,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. ​ Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Urgent Care Group

Nurse Practitioner - Clemson, SC

Description AnMed Urgent Care is seeking dedicated Nurse Practitioners to provide high-quality, compassionate care to patients in an acute care setting. Nurse Practitioners are critical to the success of our clinical teams and crucial to providing fast, friendly, and affordable healthcare. With onsite digital X-ray, EKG, common laboratory assays, our teams are able to offer a high level of care to our patients. Our centers are open 7 days per week, 8AM - 8PM. At AnMed we are pleased to offer: Work-life Balance - no on call or overnight shifts A great team environment Appreciative patients Competitive compensation AnMed allows providers to: Utilize processes that were developed by providers Work with staff hired for their ability to support providers Job Responsibilities Provide complete, compassionate care to all patients Serve as a role model and leader for that day's team Direct patient care including, but not limited to, physical exams, evaluations, diagnostic testing, diagnoses and treatment for patients of all ages Standard office procedures to include, but not limited to, incision and drainage, splinting, suturing, infection management, wound care and more Communicate test results, follow-up care, and other treatment plans as appropriate Benefits Health Insurance: Medical, Dental, Vision, Life, and Short Term Disability insurance Urgent Care: Free care for you, your spouse, and children at all AnMed locations (for those carrying UCG-sponsored or other health insurance) Retirement: 401(k) plan with employer match Paid Time Off (PTO): Vacation/CME offered CME/Licensure: Reimbursement for CME and licensure expenses Support: Employee Assistance Program (EAP) with free confidential support when you need it. EAP offers counseling and resources to support your wellbeing, including legal, financial, child, eldercare, and individual (or family) counseling. Employee Discounts: Amazon Prime reimbursement or Sam’s, Costco, or BJs base membership Verizon discount Online ticket deals Requirements Graduate of an Accredited School of Nursing Program Primary Care Nurse Practitioner with a minimum of 2 years experience in a Urgent Care or Emergency Room setting Must be licensed by the State of South Carolina DOT certification required Current Drug Enforcement Administration (DEA) License required Commitment to Urgent Care Group’s core values: Kindness, Impact, Teamwork, Efficiency, and Integrity Who is Urgent Care Group? Urgent Care Group’s (UCG) Mission is to provide fast, friendly, and affordable healthcare in every community. Based in Nashville, UCG was founded in 2017 to create the leading urgent care company. Urgent Care Group partners with premier health systems and excellent providers committed to expanding access to high-quality healthcare. The Urgent Care Group Network includes more than 55 centers operating as six brands: AnMed Urgent Care in partnership with AnMed in South Carolina, Covenant Health Urgent Care in partnership with Covenant Health in Tennessee, Health Choice Urgent Care in partnership with Northside Hospital in Georgia, Medac Urgent Care in North Carolina, MEDcare Urgent Care in South Carolina, and Total Access Urgent Care in Missouri and Illinois. For more information, visit: UrgentCareGroup.com . We are an equal opportunity employer. We celebrate diversity and are committed to building an inclusive environment for all employees and patients.
Monogram Health

Apply to Future Opportunities - Nurse Practitioner

Future Position: Advanced Practice Provider (NP/PA) - Iowa At Monogram Health, we are always looking to connect with talented professionals who share our mission of transforming healthcare for patients with chronic conditions. While we may not have an immediate opening today, we continuously gather resumes for future opportunities across our growing organization. Note: This posting is not for a current, active position. By submitting your resume, you are expressing interest in being considered for future APP roles that open within the state of Iowa. Monogram Health is seeking compassionate and skilled Advanced Practice Providers (Nurse Practitioners or Physician Assistants) to deliver high‑quality in‑home care to patients living with multiple chronic conditions, including diabetes, hypertension, chronic kidney disease, heart failure, COPD, depression, and other complex health needs. Our APP roles work within an integrated multidisciplinary care team (Clinical, Behavioral Health, Pharmacy, Administrative), establishing long-term patient relationships and providing continuity of care to complex patients in their homes and via telehealth. The Advanced Practice Provider has the opportunity to be part of a value-based, patient-centered care model, providing quality driven managed care with a population health focus. Highlights Competitive W‑2 salary with performance and anniversary bonuses Multi‑specialty training program for complex patient care Schedule Visits scheduled Monday–Friday, 8am–5pm No on‑call, overnights, weekends, including paid company holidays Average 4–6 completed visits per day 30–90 minute visit lengths PTO and reimbursement for approved CEUs are provided based on company policy *Subject to change based on business needs and performance Roles and Responsibilities Provide evidence‑based, patient‑focused care that reduces avoidable hospitalizations and improves quality of life directly in the patient’s home Perform comprehensive assessments, including initial evaluations, annual wellness exams, follow‑ups, and post‑discharge visits Educate patients and caregivers on disease management, preventive care, medications, and diagnostic testing Participate in recurring virtual integrated care team meetings Coordinate care with PCPs, specialists, and ancillary services Complete documentation accurately and in a timely manner Periodic travel may be required. Requirements Active and unrestricted RN and NP license, or Physician Assistant license Board certification (NP: ANCC/AANP | PA: NCCPA) Current and unrestricted DEA certificate, or eligibility to obtain Minimum 2 years of direct patient care experience Field‑based role requiring travel to patient homes, reliable transportation, valid driver’s license, and auto insurance BLS certification (supported during onboarding) Demonstrated initiative and independent, critical thinking, and decision making skills Knowledge of and compliance with federal/state regulations (HIPAA, OSHA) Previous experience conducting annual wellness or comprehensive visits preferred Prior experience with EHR systems (Athena, Salesforce) preferred Background in managed care, population health, or value‑based care preferred Bilingual (Spanish/English) preferred 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 patients with complex chronic conditions. Our personalized model addresses the full spectrum of patient needs—clinical, behavioral, social, and environmental. Supported by a multidisciplinary team across nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care, we deliver comprehensive care that improves outcomes, enhances quality of life, and reduces healthcare costs.
Monogram Health

Market Physician Executive (MPE)

Position: Market Physician Executive (MPE) 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). The MPE will collaborate with Monogram Health’s Multi[1]Specialty Platform to leverage employed specialists to deliver in-home specialty care. Monogram Health deploys a proven risk[1]based model to ensure health equity and health equality leveraging proprietary next generation AI algorithms to predict the appropriate level of care. Aligning with the quadruple AIM, the MPE will focus to improve patient experience, population healthoutcomes, 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. 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. Roles and Responsibilities Clinical Guidelines Execution – 25% Know, understand, and deliver on Monogram Health’s proprietary evidenced based clinical pathways. Ensure adherence to established clinical guidelines and Monogram Model of Care. Review and approve APP, RN, SW and PharmD plans of care. Appropriate and timely patient document within Salesforce and Athena clinical activities, interventions, and tasks. Review, approve and co-sign APP encounters. Clinical and Operations Performance and Quality Improvement – 25% Overall accountability for reducing total cost of care and Medical Loss Ratio. Responsible for clinical outcomes to include, but not limited to, clinical interventions closure, inpatient/outpatient utilization, pharmacological prescribing and therapy management, multi-specialty platform and HEDIS/Gap Closure Actively lead daily high risk and concurrent review rounds. Direct supervision of front line clinical and operations team members. Oversee and delegate operational responsibility to Market Manager, to deliver on daily operations, such as patient engagement, scheduling, administrative oversight, strategic implementations, and P&L management. Regularly assess and present market performance and outcomes to Executive and Senior Leaders . Patient Care and Treatment – 25% Provide direct and indirect patient care (including diagnosis and treatment of disease). Engage with patients on treatment plans, community provider collaboration, and direct evidence-based care pathways. Conduct Peer to Peers with community, facility, and health plan partners. Order labs, referrals, and complete actions to drive patient outcomes, close care gaps, and Clinical Intervention closure. Population Health Management (PHM) – 20% Provide clinical guidance and direction to Market teams to drive Population Health Management activities, including identifying and intervening on High-Risk Patients, formulating strategies to reduce admissions/readmissions, complete quality post hospital discharge visits, and improving the quality of visits. Collaborate with Medical Economics, Finance and other stakeholders to root cause and action against utilization trends impacting care and outcomes. Present and guide population health strategies in clinical and operational meetings. Conduct patient reviews to target high utilizers, high risk and high opportunity patients and patient cohorts. Miscellaneous –
Monogram Health

Advanced Practice Provider- Florence, SC

Position: 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. Monogram Health is a leading multispecialty provider of in-home, evidence-based care and benefit management services for the most complex of patients who have multiple chronic conditions 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. Responsibilities Conducts assessments, which includes comprehensive annual wellness exams on patients both in the patients' home and in the virtual environment Counsels and educates patients and families about benefits and programs available to help them live healthier lives 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 Responsible for the coordination of care with primary care providers, specialists, and appropriate ancillary services Completes all documentation and paperwork in a timely manner Maintains quality of care standards as defined by the practice 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 Deliver evidence-based, timely care in a manner that reduces avoidable hospitalizations, maximizes quality of life, and puts patient health and satisfaction first Prescribe medications, order tests, and collaborate with patient’s Monogram physician Perform effectively, as reflected by improved patient quality outcomes, which will be measured and reported daily Facilitates closing gaps in care by educating patients about preventive monitoring and working with physician practices to schedule diagnostic testing Assists patients with enrolling to access educational videos Participates in the integrated care team meetings Knowledge of disease diagnosis and prevention Make assessment of patient's health status Develop treatment plan Implement a plan consistent with appropriate plan of care Follow-up and evaluate patient's status Other duties as assigned Position Requirements Active and unrestricted Registered Nurse and Nurse Practitioner or Physician Assistant license Board certified for appropriate licensure (NP: ANCC/AANP; PA: NCCPA) Current and unrestricted DEA certificate Ability to work without direct supervision and practice autonomously Access to transportation, a valid driver's license, and car insurance Must be proficient with medical instruments and equipment required by the work Knowledge of computer-based data management programs and information systems, as well as medical records and point-of-interview technology 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 Sound understanding of all federal and state regulations including HIPAA and OSHA 2 or more years of direct patient care required Managed Care/IPA/Health Plan experience Experience conducting annual wellness visits or similar comprehensive visits virtually or in the home 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 Earn a competitive base salary Grow your clinical skillset and earn $2,500 for every core and specialty competency you complete Invest in your longevity with a $5,000 annual anniversary bonus Maximize your income potential with up to 15% in additional bonuses , including: Quarterly bonuses for quality, patient experience, and chronic condition outcomes Annual bonuses for visit cadence, wellness performance, and patient engagement A company‑wide 5% annual kicker bonus Start earning bonuses sooner — eligibility begins after just 3 months 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-SJ1