Community Health Nurse Practitioner - Marioin

Community Health Family Nurse Practitioner

Vanna Health focuses on reimagining care for individuals with mental illness. Our goal is to empower these individuals to lead healthy and meaningful lives by providing social, physical and mental healthcare support and connecting members to community programs. Our technology-enabled approach, developed by our own team of engineers and designers, ensures our staff and members are well supported.

Vanna delivers in-person and virtual community-based engagement through an interdisciplinary team of coaches and clinicians. We leverage partnerships with existing community resources to facilitate support networks unique to an individual's needs and location - connecting them to established psychosocial rehabilitation programs, resources for housing, transportation, etc. and various digital engagement opportunities to address members' needs.

Vanna Health is seeking an experienced, recovery-focused Family Nurse Practitioner (FNP) who is passionate about community care, health education and facilitating care that addresses all the dimensions of wellbeing. In this role, you will bring passion for serving individuals with mental illness and chronic physical health conditions, helping them access community-based care to improve health outcomes and quality of care for members of our Indiana locations in Marion, Lake, Allen and Vanderburgh counties.

This role focuses on conducting timely follow-up visits with members, within 1 week of discharge from the emergency department (ED) or inpatient setting for a behavioral health-related reason, either in-person in the field or via telehealth, with the goal of reducing 30-day readmissions and ED re-presentations. The FNP will support member medication adherence through education, medication reconciliation and bridge prescriptions as needed.

The FNP will also address barriers to primary care access offering same-day urgent visits to help avoid unnecessary ED utilization, medication management and optimizing chronic disease management for high utilizers with complex conditions, and participating in complex case reviews. The FNP will play a key role in care coordination, working closely with Vanna Health's interdisciplinary team to ensure continuity of care, address medical and behavioral health needs, and support engagement with outpatient services.

This position offers a flexible hybrid care delivery approach across multiple care settings with a primary base in the Indianapolis office. The role requires a strong in-person clinical presence with the flexibility of remote/telehealth coverage as clinically appropriate to support enhanced patient access to primary and behavioral health care.

Responsibilities

Deliver direct clinical care in-person in the community, including member homes or via telehealth, including:

• Conduct post-discharge follow-up visits within 7 days
• Perform comprehensive clinical assessments, including medical and behavioral health needs
• Prescribe and administer long-acting antipsychotic medications and monitoring of vital signs
• Develop and implement care plans in collaboration with an interdisciplinary team
• Coordinate care with internal team members, including RNs, physicians, coaches, community health workers, and peer specialists
• Liaise with external outpatient providers to ensure continuity of care and appropriate follow-up
• Identify and address barriers to care, including social determinants of health
• Support efforts to reduce 30-day ED revisits and hospital readmissions
• Ensure members are up to date on recommended preventive care and screenings (e.g., breast cancer screening, annual eye exams for members with Diabetes Mellitus)
• Document all encounters and care coordination activities in a timely and compliant manner
• Participate in team meetings, case reviews, and quality improvement initiatives

• Active and unencumbered Indiana State Nurse Practitioner license in good standing with prescriptive authority
• Board certification as a Family Nurse Practitioner (FNP-C)
• Credentialed with Indiana State Medicaid
• Ability to obtain credentialing with Carelon (Anthem)
• Experience working with complex…