APP Clinical Manager

Join us in transforming healthcare. Responsibilities Conduct rounds to each contracted nursing facility on a regular basis to determine if contracted providers are delivering the Longevity Health Plan Model of Care and are meeting quality and regulatory standards. Conduct periodic review meetings with contracted nursing facilities to review clinical and quality results of their ISNP residents’ care, discuss successes and opportunities for improvement, and promote open communication. Review daily clinical performance metrics and take action if not on target. Provide coaching and coverage for clinical team members as needed, including PTO and time away from work. Conduct hospitalization reviews, identify root causes, and provide coaching and feedback to facilities as part of the monthly clinical review meeting, as well as to Advanced Practice Providers (APPs). Facilitate Advanced Practice Providers onboarding, hiring, and conduct facility and clinical orientation. Ensure team performance to targeted goals. Build effective nursing facility relationships to foster LHP program success in the market. Work effectively with PCPs and other physicians. Ensure member care‑coordination activities are well managed, including member transitions out of nursing facilities to community care if needed. Escalate issues/concerns that may impact Longevity Health Plan reputation, contract compliance, relationships, or any state/regulatory laws/regulations or employment law. Work closely with Plan medical director to determine how to enhance/improve provider quality and the appropriateness of care to LHP residents. Identify learning needs of the team and work with the Director to address them. Assist with nursing facility readiness assessments and ongoing education on the Model of Care and orientation. Complete HEDIS/STARs measures reports with APPs and initiate actions. Maintain minimum weekly clinical update calls (currently more frequent due to COVID) to facilitate interaction and information sharing with colleagues. Perform chart audits as per MOC guidelines for Nurse Practitioners and provide feedback to APPs and MDCS if further interventions are needed for performance improvement. 1:1 with APPs on team, provide feedback, review APP scorecard, and provide input on APP performance appraisal to MDCS. Provide MOC oversight for all metrics and develop action plans for each metric and APP, and provide education directly to APPs and follow up to ensure compliance. Provide coaching and 1:1 ACP mentorship with RP/family and members ongoing. Provide daily coaching and case reviews with APPs on changes in condition and management of acute and chronic conditions to support field APP practice. Provide APP member coverage for facility onboarding and PTO/sick time away from work as needed, meeting all APP job competencies. Provide oversight/coordination of prior authorizations. Facilitate MTM compliance and communicate to the team of GAP reports. Initiate, track, update APP employment requirements—TB test, flu shot, licensure, certification, DEA. Perform other related duties as assigned. Qualifications State unrestricted licensed Advanced Practice Nurse with National Board certification (AANP, ANCC, or AACN) as an Adult, Family, Geriatric, or Primary Care nurse practitioner required. Alternatively, state unrestricted licensed Physician’s Assistant and NCCPA board certified with nursing home/geriatric or hospice/palliative experience. DEA license required. Active national provider number (NPI) and active Medicare provider number. Valid state driver’s license with a good driving record and proof of automobile insurance. Education & Training Master of Science in Nursing as a Nurse Practitioner from a nationally accredited program, or Master’s Degree from a nationally accredited program. Knowledge & Experience Minimum of three (3) years as an Advanced Practice Provider – Nurse Practitioner or Physician Assistant. One (1) year experience in a leadership role and one (1) year experience working in a nursing facility is strongly preferred; experience with similar populations in another setting is considered. Clinical background in nursing homes or supervising staff in nursing homes, or working with similar patient populations, clinical quality program implementation, utilization management program policies/procedures, and managed care plan experience with complex vulnerable populations. Knowledge of applicable State and Federal regulations, Medicare Advantage Institutional Special Needs Plans Model of Care, STARS‑Quality Program requirements, NCQA requirements, and other regulations. Computer proficiency, including Microsoft Office, electronic medical records, data compilation, and analysis for management and marketing. Excellent verbal and written communication skills, strong interpersonal skills, public presentation skills, and highly organized. Ability to work independently with minimal supervision in a fast‑paced environment. Willingness to follow policies and procedures, work as a team member, support Health Plan programs, and represent Longevity Health Plan positively. Supervisory Responsibilities Accomplish department objectives by supervising staff and organizing and monitoring work processes. Recruit, select, orient, and train employees, and develop personal growth opportunities. Communicate job results by coaching with direction from MDCS. Plan, monitor, and appraise job results. Conduct training and implement and enforce systems, policies, and procedures. Maintain a safe and healthy work environment by establishing and enforcing organizational standards and adhering to legal regulations. Develop schedules, assign and monitor work, gather resources, implement productivity standards, resolve operations problems, maintain reference manuals, and implement new procedures. Control expenses by gathering and submitting budget information, scheduling expenditures, monitoring variances, and implementing corrective actions. Provide quality service by enforcing quality and customer service standards. Contribute to team effort by accomplishing related results as needed. Manage the hospital tracker by inputting all hospital transfers, returns from hospital, notes from hospital review meetings, and Skill Part A and B services. Provide ongoing education after hospital review meetings on takeaways to APPs and dispositions. Review HEDIS, STARs, and MTMs with the APPs, track them, and provide ongoing support for field APPs. Ensure compliance with all federal and state regulatory requirements—CMS, DOH, BON, HIPAA, MIPPA, cybersecurity, and LHP policies and procedures. Longevity Health is an Equal Opportunity Employer . We value diversity and encourage applicants of all backgrounds to apply. Longevity Health follows federal and state regulations regarding COVID‑19 vaccinations. Some facilities may still require staff vaccinations to protect the health of residents. Applicants will be required to provide proof of vaccination, or an approved exemption, where applicable. #J-18808-Ljbffr