Regional Manager Nurse Practitioner

Regional Manager Nurse PractitionerNurse Practitioner or Physician Assistant NP PA- PruittHealth Premier Services Long Term Care Health Plan - Must be licensed in SC Monday -Friday with Flexibility No Eve or Weekend onsite RequiredJOB PURPOSE: The Regional Clinical Lead Nurse Practitioner provides clinical, operational, and professional leadership to advanced practice providers within an assigned region while serving in an active Nurse Practitioner role. This leader partners with physicians, facility leadership, operations, quality, care management, and interdisciplinary teams to ensure exceptional care delivery, strong provider performance, regulatory compliance, and positive member outcomes.KEY RESPONSIBILITIES:Provide day-to-day leadership, clinical support, coaching, and escalation assistance to assigned Nurse Practitioners and Physician Assistants across a defined region or provider pod.Maintain active clinical practice if needed to cover vacancy or for providers on FMLA and perform assigned coverage, rounding, assessments, and member care responsibilities consistent with approved workload expectations.Support regional provider staffing and coverage by reviewing caseloads, facility assignments, schedules, vacancies, leave, on-call needs, and temporary coverage requirements; escalate capacity risks and recommend practical solutions.Develop and maintain provider call and coverage schedules, support PTO/leave coordination, and help ensure continuous service to assigned members and facilities.Participate in candidate interviews and selection; establish individualized onboarding and orientation plans; coordinate clinical training, systems access follow-up, facility introductions, and competency development for new providers.Serve as mentor and clinical resource for providers, including guidance on complex member needs, medication reconciliation, ancillary services, preventive care, transitions, escalation pathways, HCC coding, quality metrics and collaboration with physicians and specialists.Lead or support recurring provider meetings, education sessions, clinical calls, and regional huddles using clear agendas, defined expectations, and follow-up on unresolved action items.Coordinates, with the support of recruiting department, the recruiting and selection of Pruitt Health Nurse Practitioners (NP), assures an adequate pipeline for growth and expansion of PruittHealth Premier.Oversee the coordination and execution of the Nurse Practitioner orientation, including education and support to understand PruittHealth clinical services platform for PruittHealth Premier.Implement professional development programs and clinical education for nurse practitionersTranslate plan, regulatory, clinical, pharmacy, utilization, quality, and operational updates into understandable provider guidance; maintain and share current orientation tools, workflows, and reference materials.Reinforce timely, complete, and accurate documentation of face-to-face and non-face-to-face clinical work, including orders, recommendations, care coordination, on-call interactions, transitions, and follow-up activities.Monitor and act on available provider and facility performance information, including HRA completion, individualized care plans, ICT activity, documentation timeliness, HCC/risk gaps, HEDIS/Stars opportunities, preventive care, utilization, and hospitalization trends.Distribute and review actionable HEDIS, Model of Care and HCC gap and performance lists with assigned providers; establish follow-up expectations, remove barriers, validate completion, and escalate unresolved concerns through the appropriate leadership pathway.Conduct or coordinate documentation and clinical workflow audits, identify trends and training needs, and partner with providers on corrective action and sustained improvement.Partner with facility Administrators, Directors of Health Services, physicians, medical directors, pharmacy consultants, nursing leaders, case management, member advocates, utilization management, quality, compliance, and operations to coordinate care and resolve barriers.Promote regular communication between assigned providers and facility medical directors/attending physicians, including timely escalation of clinical, coverage, operational, and relationship concerns.Support safe transitions across levels and sites of care and ensure clinically important information, care plans, follow-up needs, and provider assignments are communicated to the receiving team.Ensure provider practice aligns with PruittHealth Premier policies, clinical pathways, approved workflows, benefit requirements, Model of Care expectations, and applicable CMS, state, federal, and professional standards.Participate in Quality Assurance and Performance Improvement activities and other plan or facility initiatives focused on member outcomes, avoidable hospitalization reduction, quality, compliance, and member experience.Collaborate with leadership on program growth, regional alignment, implementation of new services, workflow redesign, and adoption of clinical technology and reporting tools.Model accountability, professionalism, responsiveness, sound judgment, collaboration, and effective prioritization; complete other duties assigned based on business and member needs.KNOWLEDGE, SKILLS, ABILITIES:Clinical Leadership Provide day-to-day clinical guidance and support to assigned Nurse Practitioners and Physician Assistants. Serve as a clinical resource for complex patient cases, care coordination challenges, and escalation situations. Support clinical decision-making and evidence-based practice standards. Promote best practices in assessment, diagnosis, documentation, medication management, and care planning. Assist providers in delivering high-quality, patient-centered care across the continuumProvider Development & Team Leadership Mentor, coach, and develop advanced practice providers. Participate in interviewing, hiring, onboarding, and orientation of new providers. Conduct regular provider check-ins and assist with professional development planning. Support provider education related to documentation, coding, quality measures, Model of Care requirements, and clinical workflows. Assist leadership with provider performance monitoring and accountability initiatives.Quality & Performance Improvement Partner with operational and clinical leadership to improve quality outcomes and reduce avoidable hospitalizations. Support initiatives related to: Model of Care metrics HCC/Risk Adjustment HEDIS Measures Star Ratings Hospitalization Reduction (ADK) Monitor provider compliance with established clinical and operational standards.Operational Oversight Assist with provider scheduling, coverage planning, PTO coordination, and call schedules. Support facility coverage plans and staffing allocation within assigned regions. Identify and resolve operational barriers impacting provider success. Collaborate with operations leadership regarding workflow optimization and process improvement initiatives. Build strong relationships with facility leadership, physicians, medical directors, nursing teams, and interdisciplinary partners. Assist with caseload coverage if there is a vacancy in your assigned region and one of your providers cannot offer coverage.MINIMUM EDUCATION REQUIRED: Master's Degree or Doctorate from an accredited Adult, Family, Gerontology, Adult-Gerontology, or Geriatric Nurse Practitioner program. Current unrestricted Nurse Practitioner license in state(s) of practice. National Board Certification (AANP or ANCC). Current CPR/BLS certification.MINIMUM EXPERIENCE REQUIRED: Minimum five (5) years of Nurse Practitioner experience. Demonstrated experience managing medically complex adult or geriatric populations. Prior leadership, mentoring, supervisory, or provider development experience preferred. Long-term care, skilled nursing, Medicare Advantage, I-SNP, D-SNP, or value-based care experience strongly preferred.MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW: Current, active, and unrestricted Registered Nurse and Advanced Practice Registered Nurse/Nurse Practitioner licensure in each state of practice. Current national board certification through AANP or ANCC in an applicable population focus. Current CPR/BLS certification. Must meet all applicable collaborative, prescriptive authority, credentialing, and payer enrollment requirements.ADDITIONAL QUALIFICATIONS: Long-term care, skilled nursing facility, Medicare Advantage, I-SNP, D-SNP, value-based care, HCC/risk adjustment, HEDIS/Stars, and Model of Care experience preferred. Proficiency with electronic medical records, clinical reporting tools, Microsoft 365, Excel, Teams, and virtual meeting platforms preferred.Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.