Lead Nurse Practitioner

Lead Nurse Practitioner
- Hybrid - with limited daytime travel

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

To develop our Nurse Practitioner (NP) program in support of Pruitt Health 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 Pruitt Health Premier Model of Care.

In addition, this position is primarily remote but there is require travel to corporate office and skill nursing facilities (SNF).

• Provides expertise to the training and onboarding of Plan Provider NPs.
• Proven ability to provide clinical and personnel development feedback for continued clinical and professional development
• Participates in and/or directs Quality Assurance Performance Improvement (QAPI) activities.
• Understands the Pruitt Health Premier Plan benefits, Pruitt Health Premier Plan policies, procedures and articulate them effectively to providers, members, and key decisions makers.
• 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.
• 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.
• 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.
• Utilizes internal audit tracking tools for review and validation of PHP Model of Care required documentation.
• Collaborates with SNF facility DON, Administrators, ISNP VP Operations and Medical Director to execute the implementation of the clinical quality initiatives
• 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
• Works with external teams/downstream vendors on data reporting
• Reviews data for possible data integrity and data deficits
• Prepares Agendas and Training Material

• 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…