Comprehensive Care Advanced Practitioner

4 days ago


Oklahoma City, Oklahoma, United States Archwell Health Full time
Job Summary:

The Comprehensive Advanced Care Practitioner will be an integral part of the clinical team at ArchWell Health, a new and innovative healthcare provider dedicated to improving the lives of senior members. The successful candidate will be responsible for delivering high-quality care to our highest priority members, either in-center or through our telehealth platform, and closing all remaining care gaps for the calendar year in a single visit.

Key Responsibilities:
  • Prospective Chart Prep: Conduct thorough chart reviews to identify clinical diagnostic and quality opportunities for identified members, ensuring a plan is in place to comprehensively address open care gaps for every member encounter.
  • Scheduling and Prioritization: Collaborate with center leadership and care team members to ensure members are prioritized for scheduling based on outstanding care gaps, maintaining a target schedule template fill rate of 75%.
  • Encounter Completion: Complete encounters with identified members in-center or using our approved telehealth platform(s), addressing all historical and suspected conditions presented via point-of-care interface.
  • HEDIS Measures and Point-of-Care Testing: Address all open HEDIS measures, including performing point-of-care testing that can be closed in an ArchWell Health center.
  • Interpretation and Formulation: Interpret evidence-based practice screenings, including point-of-care testing, and formulate a list of current medical conditions using clinical knowledge and judgment.
  • Documentation and Referral: Document an assessment and plan for all chronic conditions in the EMR to align with the PCP treatment plans, and refill routine medication in appropriate quantities per ArchWell Health's Standing Order.
  • Follow-up and Communication: Coordinate appropriate follow-up care and maintain effective communication with the members' assigned care team to facilitate effective continuity of care.
  • Urgent and Emergent Situations: Identify urgent and emergent situations and intervene appropriately.
  • Patient Education: Educate members on topics such as disease process, preventative screening schedule, and medication adherence.
  • Engagement and Training: Maintain a high level of engagement, attend all training sessions and center meetings, and demonstrate strong proficiencies with Clinical Documentation Improvement (CDI) education.
  • Encounter Notes and Metrics: Complete and lock Encounter Notes timely as per ArchWell Health's standards, and perform at above-average member experience metrics.
Requirements:
  • Education and Licensure: Active NP or PA license or ability to obtain by start date, with licensure unencumbered and free of any open/unresolved disciplinary actions.
  • Certification: Active ANCC, AANP, or PA national certification in Family, Geriatrics, Adult, Adult-Gerontology Primary Care, or Adult-Gerontology Acute Care certification.
  • Experience: 1+ years of clinical experience in their highest level of education, clinical setting, with experience in gerontology, cardiology, internal medicine, or endocrinology.
  • Travel: Ability to travel within the license state if requested for additional incentives (with notice, based on business needs).
Knowledge, Skills, and Abilities:
  • Electronic Medical Records: Experience with Electronic Medical Records.
  • ICD-10 Diagnosis Codes: Advanced knowledge of ICD-10 diagnosis codes.
  • Diagnostic Criteria: Advanced knowledge of diagnostic criteria.
  • Medicare Advantage: Medicare Advantage experience, including knowledge of the HCC model and STARs.
  • Patient Care Planning: Ability to create, plan, implement, and evaluate patient-specific care plans.
  • Independent Judgment: Ability to exercise use of independent judgment.
  • Cultural Sensitivity: Sensitivity to the diverse needs of culturally diverse staff, patients, and communities.
  • ArchWell Health Values: Embodies and serves as a role model of ArchWell Health's Values:
    • Be compassionate
    • Strive for excellence
    • Earn trust
    • Show respect
    • Stay resilient
    • Always do the right thing


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