Advanced Practice Clinician, Integrated Care Delivery (San Bernardino County)

Responsibilities Provide and coordinate primary care to an assigned panel of SCAN members in their place of residence (senior living communities or skilled nursing facilities). Conduct physical/wellness examinations, assessments, and occasionally urgent medical visits; provide telephonic triage to ensure timely, appropriate care and hospital avoidance. Administer vaccines and order/interpret diagnostic tests. Initiate goals‑of‑care conversations with patients, families, and living‑community staff and manage chronic disease treatment plans. Identify patient health‑care needs and develop comprehensive care plans, collaborating with case management for timely access to necessary services. Manage visitation schedules in line with established practice protocols and adjust based on members’ needs and acuity. Engage with primary care physicians and other health‑care professionals in collaborative relationships aimed at disease prevention, health promotion, and chronic disease management. Partner closely with primary care physicians for clinical oversight and guidance. Connect with specialists, hospitals, ancillary care providers, and community‑based organizations to ensure continuity of care, promote shared decision‑making, and advocate for members. Actively monitor and address clinical quality gaps in partnership with other providers. Document member visits and interactions promptly, following practice protocols. Serve as a direct resource for members, families, community staff, and support personnel. Participate with the Integrated Care Sales team in events to build member awareness and educate communities. Initiate and complete virtual health visits to promote accurate triaging and reduce travel time. Participate in the on‑call program available to members after hours and on weekends. Maintain professional and technical knowledge by attending educational workshops and reviewing professional publications. Contribute to team efforts to meet quality healthcare goals by closing care gaps, attending high‑risk group discussions, and optimizing clinical workflows and protocols. Other duties as assigned. Qualifications Master’s degree in Nurse Practitioner Certificate or Master’s from an accredited Physician Assistant program; education in adult/geriatric medical care preferred. Current California Nurse Practitioner license or California Physician Assistant Certification (PA‑C) in good standing. Wound Care Certificate and Palliative Care Certificate – a plus. Knowledge of treatment of complex chronic diseases, such as dementia, diabetes, heart failure, and COPD. Ability to identify health‑care needs and refer and coordinate with other resources/programs appropriately. Knowledge of HCC and ICD‑10 coding and documentation. Knowledge of wound care and management. Knowledge of CMS guidelines and Medicare Advantage Managed Care. Comfortable initiating goals‑of‑care and end‑of‑life discussions. Strong interpersonal skills and a change‑agent mindset for building relationships with health‑care teams and patients. Knowledge of and ability to maintain HIPAA requirements. Adaptable and open to change and problem‑solving. Basic technological proficiency (Word, Excel, PowerPoint, Outlook, EMR) and openness to new technology. Physical ability to stoop, kneel, crouch, bend, reach, lift, pull, push, and carry up to 10lbs regularly and up to 50lbs occasionally. Multilingual/multicultural capability – a plus. Travel (75%+ of time in the assigned area); must have a valid driver’s license, automobile insurance, and reliable transportation. Benefits Base salary range: $125,400.00 to $179,300.00 annually. Quarterly bonus program. Robust wellness program. Generous paid‑time‑off (PTO). Eleven paid holidays per year, plus one additional floating holiday. 401(k) retirement savings plan with employer match and contribution. Robust employee recognition program. Tuition reimbursement. Tuberculosis Screening Policy To ensure the health and safety of our members, job offer with SCAN is contingent on providing proof of a recent tuberculosis screening upon hire or proof of a negative screening within the last year. Equal Employment Opportunity SCAN is a proud Equal Employment Opportunity and affirmative action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, marital status, disability, protected veteran status, or any other status protected by law. A background check is required. The contractor will not discharge or discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Employees who have access to compensation information may not disclose it except pursuant to a formal complaint, investigation, or as required by law, consistent with 41CFR60‑1.35(c). #J-18808-Ljbffr SHPCA SCAN Health Plan