Physicians Comprehensive Care Advanced Care Practitioner

Comprehensive Care Advanced Care PractitionerArchWell Health is a new innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable accessible neighborhood clinics where seniors can feel at home and become part of a vibrant wellness-focused community. Our members experience greater continuity of care as well as the comfort of knowing they will be treated with respect by people who genuinely care about them their families and their Summary:The Comprehensive ACP reporting to the Market Medical Director will be an integral part of the clinical team. The Comprehensive ACP is responsible for seeing our highest priority members either in-center or through the telehealth platform and closing all remaining care gaps for the calendar year in a single Duties/Responsibilities:Conduct Prospective Chart Prep for clinical diagnostic and quality opportunities of identified members sufficiently in advance of member visits to ensure there is a plan to comprehensively address open care gaps for every member with center leadership and care team members to ensure members are prioritized for scheduling based on outstanding care gaps and maintain a target schedule template fill rate of 75%.Complete encounters with identified members in-center or using ArchWell Healths approved telehealth platform(s).Address all historical and suspected conditions presented via point of care interface (VIM).Address all open HEDIS measures of Focus On Care (FOC) including performing point of care testing that can be closed in an ArchWell Health center. Interpret evidence-based practice screenings including point of care a list of current medical conditions using clinical knowledge and an assessment and plan for all chronic conditions in the EMR to align with the PCP treatment routine medication in appropriate quantities per ArchWell Healths Standing Order (see attached). Controlled substances are excluded from this Standing Order and should be referred to PCP. Coordinate appropriate follow up care and maintain effective communication with the members assigned care team to facilitate effective continuity of urgent and emergent situations and intervene members on topics such as disease process preventative screening schedule and medication a high level of engagement and attend all training sessions and center meetings; demonstrate strong proficiencies with Clinical Documentation Improvement (CDI) education; and assist other providers to understand CDI and lock Encounter Notes timely as per ArchWell Healths at above-average member experience Education and Experience:Active NP or PA license or ability to obtain by start date. Licensure must be unencumbered free of any open/unresolved disciplinary actions including probation or restrictions against privilege to ANCC AANP or PA national certification in Family Geriatrics Adult Adult-Gerontology Primary Care or Adult-Gerontology Acute Care certificationAbility to complete physical requirements of the job including lifting a 30-pound bag in and out of the car navigating stairs and a variety of dwelling conditions and sit stand and kneel to perform physical assessment.1 years of clinical experience in their highest level of education clinical settingExperience in gerontology cardiology internal medicine or endocrinologyAbility to travel within license state if requested for additional incentives (with notice based on business needs)Knowledge Skills and Abilities:Experience with Electronic Medical RecordsAdvanced knowledge of ICD-10 diagnosis codes Advanced knowledge of diagnostic criteriaMedicare Advantage experience including knowledge of the HCC model and STARs measures Ability to create plan implement and evaluate patient specific care plansAbility to exercise use of independent judgementSensitivity to the diverse needs of culturally diverse staff patients and communitiesEmbodies and serves as a role model of ArchWell Healths Values:Be compassionateStrive for excellenceEarn trustShow respectStay resilientAlways do the right thingArchWell Health is a new innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable accessible neighborhood clinics where seniors can feel at home and become part of a vibrant wellness-focused community. Our members experience greater continuity of care as well as the comfort of knowing they will be treated with respect by people who genuinely care about them their families and their communities.