Leads and manages team of nurse practitioners focused on preventive primary care and medical care services to patient members. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
• Works in collaboration with supervising physicians to perform comprehensive member medical assessments, orders appropriate tests/procedures for diagnostic purposes, formulates treatment plans, obtains specialist consultations as needed and documents as required.
• Provides support for nurse practitioners including: proper hierarchical condition category (HCC), appropriate coding of clinic and in home assessed patients, evaluation of charts of ACE/homebound, Healthcare Effectiveness Data and Information Set (HEDIS) coaching and capture, evaluation of progress notes for completeness and proper coding, and resource for clinical questions and concerns prior to involvement of the medical director.
• Works in a variety of settings (non-clinical or clinical settings) and provides medical care to all levels of members. Some programs/clinics may focus on specific populations (e.g., adult, geriatric, pediatric).
• Oversees nurse practitioners and manages specified programs as required.
• Engages in practices constituting the practice of medicine in collaboration with and under the medical direction and supervision of a licensed physician to the degree required by state laws. May also function as and perform all duties reasonably expected and assigned to a registered nurse, such as medication administration.
• Understands when a patient needs physician oversight and when the member medical condition may be beyond the scope of knowledge of a nurse practitioner.
• Communicates directions and instructions clearly and effectively.
• Demonstrates respect for willingness to work with members remembering that the member's well-being is first priority.
• Develops rapport with members and determines member needs and wishes.
• Demonstrates honesty in dealing with members and colleagues.
• Demonstrates competence for colleagues when questions of clinical judgment arise.
• Shares information and concerns with other members of the profession by attending meetings regularly.
• Provides advice and encouragement to potential newcomers to the profession.
• Represents Care Connections to the professional community and the general public as requested.
• Questions the member to ascertain past medical and surgical history as well as a description of any current presenting signs.
• Explains physical examination findings.
• Provides in-person and telecommunication consultation, including follow-up calls for result reports, etc.
Specific Duties:
STAFF MANAGEMENT
• Provides leadership to practitioners in the cluster, fostering a team approach to deliver medical care and services to members.
• Leads nurse practitioners in the effective delivery of member care services.
• Enforces rules, regulations and policies within the cluster and implement action taken by the company.
• Participates in the administration of the nurse practitioner through cooperation with the medical director in the matters affecting member care services.
• Coordinates in home assessment (IHA) assignments and all practitioner schedules.
• Reviews Kronos paid time off (PTO) accruals and approve al PTO/continuing medical education (CME)/administrative continuing education leaves in accordance with Molina policies.
• Ensure schedule changes are communicated appropriately to key parties.
• Ensure auditing of appropriate mileage claimed prior to approval per policy.
• Conducts effective nurse practitioner meetings and sets agenda with medical director which includes review of policies and procedures, staffing issues, utilization issues, or quality improvement issues.
• Informs practitioners of staffing schedule, productivity and access issues.
• Monitors practitioners on time (punctuality) performance and all scheduling changes in accordance with the requirements of the company.
• Monitors practitioners Epic In basket to ensure appropriate and timely completion of all in basket responsibilities.
• Coaches nurse practitioner's as necessary and fosters an educational environment.
• Assists in the assessment of nurse practitioner's.
• Keeps member records complete and up-to-date to assist colleagues in appropriate management of the member.
• Assignment of quarterly peer review at the discretion of the medical director.
• Participates in the interview of practitioner candidates and the selection of the new practitioners.
• Assist in the orientation of new practitioners.
• Makes one available to cluster practitioners to keep them informed, helps resolve practitioner problems, and provides feedback on job performance on an ongoing basis.
• Assists in the annual performance evaluation of cluster practitioners based on criteria developed by the company.
Clinical Duties:
• May provide general medical care to various and/or specific member levels – adults and geriatric.
• Performs comprehensive evaluations including history and physical exams for risk adjustment and other regulatory assessments.
• Addresses both chronic and acute primary care complaints, and able to ascertain medical urgency.
• Establishes and documents reasonable medical diagnoses.
• Seeks specialty consultation as appropriate.
• Orders pertinent diagnostic laboratory and radiology testing for the medical diagnosis or presenting symptoms; demonstrated ability to work within an environment of limited resources, therefore using diagnostic tests judiciously and appropriately.
• Discusses unusual or unclear symptoms or results with consulting physician in a timely manner.
• Accepts feedback and direction from the supervising physician.
• Creates and implements a medical plan of care.
• Performs diagnostic and/or therapeutic procedures within level of training and expertise, and as outlined on the practice agreement and written protocols with the supervising physician.
• Prescribes medications as appropriate.
• Remains knowledgeable on current therapies.
• Performs timely documentation in medical records in the electronic medical record computer (EMR) system.
• Local travel may be required (based upon state/contractual requirements).