Lead Nurse Practitioner

Lead Nurse Practitioner - Hybrid - with Limited Daytime Travel

Long Term Post Acute Care Experience Highly Preferred -I-SNP Medicare Advantage

JOB PURPOSE:

To develop our Nurse Practitioner (NP) program in support of PruittHealth Premier (PHP), an I-SNP Medicare Advantage Health plan. This includes the establishment and implementation of protocols, policies, and procedures for NPs across their scope of work as well as the recruitment, selection, training, and leadership of these NPs

This role works collaboratively with physicians/medical directors, case managers, social workers, family members, key care givers and any appropriate ancillary medical personnel of the long-term care delivery system to achieve the goals and objectives of PruittHealth Premier Model of Care. In addition, this position is primarily remote but there is required travel to corporate office and skill nursing facilities (SNF).

KEY RESPONSIBILITIES:

1. Provides expertise to the training and onboarding of Plan Provider NPs.

2. Proven ability to provide clinical and personnel development feedback for continued clinical and professional development

3. Participates in and/or directs Quality Assurance Performance Improvement (QAPI) activities.

4. Understands the PruittHealth Premier Plan benefits, PruittHealth Premier Plan policies, procedures and articulate them effectively to providers, members, and key decisions makers.

5. Assesses the medical necessity/effectiveness of ancillary services to determine the appropriate initiation of benefit events and communicate the process to providers and appropriate team members.

6. Coordinates care as member's transition through different levels of care and care settings, ensures that the ICP is communicated Immediately and/or no later than 24 hours to the receiving care setting.

7. Provides leadership and support of the I-SNP NP plan providers to reinforce and support development of Care Plans to ensure interventions are in place and outcomes are achieved.

8. Utilizes internal audit tracking tools for review and validation of PHP Model of Care required documentation.

9. Collaborates with SNF facility DON, Administrators, ISNP VP Operations and Medical Director to execute the implementation of the clinical quality initiatives

10. Works with EHR provider on the interpretation of technical specifications and impact of data collection tools and reports utilized for support of PHP required metrics for CMS, HEDIS and other quality accredited documentation

11. Works with external teams/downstream vendors on data reporting

12. Reviews data for possible data integrity and data deficits

13. Prepares Agendas and Training Material

KNOWLEDGE, SKILLS, ABILITIES:

Pertinent Clinical Work Experience which is relevant to population being served.

Reviews and interprets the medical and social history of members

Interprets laboratory data, recommend appropriate follow-up, reconcile medications

Manages both medical and behavioral chronic and acute conditions effectively in collaboration with a physician or specialty provider

Synthesizes information and easily diagnoses and creates a comprehensive plan of care.

Ensures that individual plan of care is developed with specific interventions designed to meet the needs identified in the Health Risk Assessment

Audit the NPs documentation and completion of comprehensive assessments to ensure compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations

Audit the completion of Health Risk Assessment within seven (7) days of enrollment for a new beneficiary and annually within one year of the initial assessment.

Ensures all diagnoses are ICD-10 coded accurately and documented appropriately to support the diagnosis at that visit

Reviews orders and interventions for appropriateness and response to treatment to identify most effective plan of care that aligns with the member's needs and wishes

Evaluates plan of care for cost effectiveness while meeting the needs of members, families, and providers to decreases high costs, poor outcomes, and unnecessary hospitalizations

Will be required to participate in administrative on-call program, and may be required to participate in the on-call rooster as needed

Performs other duties as assigned

MINIMUM EDUCATION REQUIRED:

1. Graduate of an accredited Adult, Geriatric or Family Nurse Practitioner Master's Degree program.

2. Current and unrestricted, RN and NP licensure in state of practice.

3. Current CPR certification

MINIMUM EXPERIENCE REQUIRED:

1. Minimum 5 years clinical experience as a Nurse Practitioner in geriatric, adult, or family practice setting.

2. Previous long-term care experience

3. Proven ability to perform comprehensive, adult/geriatric physical exam. Ability to lead and manager other healthcare professionals, particularly NPs.

4. Ability to use IT tools and programs including EMR, Microsoft Office Suite, Excel, etc.

5. Excellent communication skills written and verbal

ADDITIONAL QUALIFICATIONS: (Preferred qualifications)

1. I-SNP experience strongly preferred.

2. Virtual administrative management of a clinical team

Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.

We are eager to connect with you! Apply Now to get started at PruittHealth!

As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.